What is the Improvement Activities Performance Category?
Improvement activities are a performance category under the Merit-Based Incentive Payment System (MIPS) pathway of the MACRA Quality Payment Program. In 2017, improvement activities are also one of the three performance categories that will be considered for determining a MIPS eligible clinician's overall MIPS performance. Starting in 2018, four performance categories will be considered and weighted for scoring a clinician’s overall performance under MIPS. Improvement activities reporting will account for 15% of each clinician’s overall MIPS score for the 2017 reporting year (Year 1).
To participate in the improvement activities performance category under MIPS, clinicians may choose from 92 activities, weighted to be worth either 10 or 20 points each, and which fall under one of the following 9 subcategories:
1. Expanded Practice Access
2. Population Management
3. Care Coordination
4. Beneficiary Engagement
5. Patient Safety and Practice Assessment
6. Participation in an APM
7. Achieving Health Equity
8. Integrating Behavioral and Mental Health
9. Emergency Preparedness and Response
What are the MIPS improvement activities reporting requirements for the 2017 performance year?
Under MIPS, eligible clinicians are required to attest to CMS that they completed one or more improvement activities during the performance period. For most participants and most Improvement Activities, the requirements will need to be completed for a minimum of 90 days. Eligible clinicians participating in a Partial Year (90-day) or Full Year performance period may choose one of the following combinations to earn the maximum 40 points for this performance category under MIPS:
- 2 high-weighted activities
- 1 high-weighted activity and 2 medium-weighted activities
- At least 4 medium-weighted activities
Eligible clinicians participating at the Test level may submit 1 improvement activity of a high or medium weight.
Per CMS, certain flexibilities are available for this performance category as detailed below:
- Groups with 15 or fewer participants, non-patient facing clinicians, or clinicians in a rural or health professional shortage area will earn double points for each weighted improvement activity, so medium-weight activities will be worth 20 points and high-weighted activities will be worth 40 points.
- Participants in certified patient-centered medical homes, comparable specialty practices, or an Alternative Payment Model (APM) designated as a Medical Home Model will automatically earn full credit (40 points).
- Shared Savings Program Track 1 or Oncology Care Model participants will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be 40 points.
- Participants in any other APM will automatically earn half credit (20 points) and may report additional improvement activities to increase their score to earn full credit (40 points).
How is the improvement activities performance category scored for the 2017 performance year?
In 2017, the maximum number of points that an eligible clinician can earn for the improvement activities performance category is 40 points. Activities are assigned weights of high or medium and points are designated based on activity weight. The MIPS eligible clinician’s final improvement activities performance category score will account for 15% of their overall MIPS score. For more details on MIPS scoring please click here.
Alternate Activity Weights*
Medium = 10 points
High = 20 points
Medium = 20 points
*For clinicians in small, rural, and underserved practices or with non-patient facing clinicians or groups.
For clinicians in a patient-centered medical home, Medical Home Model, or similar specialty practice.
To calculate the final improvement activities performance category score, the number of points earned by a clinician for completed activities will be divided by the number of available points (40). The resulting number will then be multiplied by 100, which will be that clinician’s final improvement activities score.
For example: a clinician who has earned 30 out of 40 available points will receive a final category score of 75.
CMS has published guidance to help providers better understand the documentation they should retain around meeting MIPS requirements. CMS calls this guidance "MIPS Data Validation Criteria" because it describes the types of documentation that would validate the data the provider submits to CMS at the end of the performance period. You can learn more about this by reviewing the CMS’ MIPS Data Validation Fact Sheet and you can see the specific documentation guidelines applicable to the Improvement Activities in the CMS’ MIPS Data Validation Criteria for Improvement Activities.
Visit Practice Fusion’s Quality Payment Program resource center here.
Further details regarding the MIPS program requirements can be found here.
CMS also provides further resources about the Quality Payment Program here.