Which Improvement Activities Qualify for the Advancing Care Information (ACI) Bonus Score in 2017?

The table below identifies the set of improvement activities from the Improvement Activities performance category of the Merit-Based Incentive Payment System (MIPS) that can be tied to the objectives, measures, and Certified EHR Technology (CEHRT) functions of the Advancing Care Information (ACI) performance category. If the improvement activity requirements are met using CEHRT, these activities can qualify for the available 10% bonus score in the Advancing Care Information performance category of MIPS for the 2017 reporting year.

Improvement Activity Performance Category Subcategory

Activity Name

Activity

Improvement Activity Performance Category Weight

Related ACI Transition Measure(s)

Expanded Practice Access

Provide 24/7 access to eligible clinicians or groups who have real-time access to patient’s medical record.

Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g. cross-coverage with access to medical record) that could include one or more of the following:

  • Expanded hours in evenings and weekends with access to the patient medical record;
  • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits, and alternative locations; and/or
  • Provision of same-day or next day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.

High

Population Management

Anticoagulant management improvements

MIPS eligible clinicians and groups who prescribe oral Vitamin K antagonist therapy (warfarin) must confirm that, in the first performance period, 60% or more of their ambulatory care patients receiving warfarin are being managed by one or more of these improvement activities:

  • Patients are being managed according to validated electronic decision support and clinical management tools that involve systematic and coordinated care, incorporating comprehensive patient education, systematic INR testing, tracking, follow-up, and patient communication of results and dosing decisions;
  • For rural or remote patients, patients are managed using remote monitoring or telehealth options that involve systematic and coordinated care, incorporating comprehensive patient education, systematic INR testing, tracking, follow-up, and patient communication of results and dosing decisions; and/or
  • For patients who demonstrate motivation, competency, and adherence, patients are managed using either a patient self-testing (PST) or patient-self-management (PSM) program. The performance threshold will increase to 75% for the second performance period and onward. Clinicians would confirm that 60% (for the first year) or 75% (for the second year) of their ambulatory care patients receiving warfarin participated in an anticoagulation management program for at least 90 days during the performance period.

  • High

  • Provide Patient Access
  • Patient-
  • Specific Education
  • View, Download, Transmit (VDT)
  • Secure Messaging
  • Health Information Exchange

Population Management

Glycemic management services

For outpatient Medicare beneficiaries with diabetes and who are prescribed antidiabetic agents (e.g. insulin), MIPS eligible clinicians and groups must attest to having:

  • For the first performance period, at least 60% of medical records with documentation of an individualized glycemic treatment goal that:

    • Takes into account patient-specific factors, including at least 1) age, 2) comorbidities, and 3) risk for hypoglycemia, and

    • Is reassessed at least annually.

  • The performance threshold will increase to 75% for the second performance period and onward.
  • Clinicians would confirm that 60% (for the first year) or 75% (for the second year) of their medical records that document individualized glycemic treatment represent patients who are being treated for at least 90 days during the performance period.

High

  • None

Population Management

Chronic care and preventative care management for empaneled patients

Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following:

  • Provide patients annually with an opportunity for development and/or adjustment of an individualized care plan as appropriate to age and health status, including health risk appraisal, gender, age and condition-specific preventive care services, care plan for chronic conditions, and advance care planning;
  • Use condition-specific pathways for care of chronic conditions (e.g. hypertension or asthma) with evidence-based protocols to guide treatment to target;
  • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions;
  • Use panel support tools (registry functionality) to identify services due;
  • Use reminders and outreach (e.g. phone calls or patient portal) to alert and educate patients about services due; and or
  • Routine medication reconciliation.

Medium

  • Provide Patient Access
  • Patient-
  • Specific Education
  • VDT
  • Secure Messaging
  • Health Information Exchange

Population Management

Implementation of methodologies for improvements in longitudinal care management for high risk patients

Provide longitudinal care management to patients at high risk for adverse health outcome or harm that could include one or more of the following:

  • Use a consistent method to assign and adjust global risk status for all empaneled patients to allow risk stratification into actionable risk cohorts. Monitor the risk-stratification method and refine as necessary to improve accuracy of risk status identification;
  • Use a personalized care plan for patients at high risk for adverse health outcome or harm, integrating patient goals, values and priorities; and/or
  • Use on-site practice-based or shared care managers to proactively monitor and coordinate care for the highest risk cohort of patients.

Medium

  • Provide Patient Access
  • Patient-
  • Specific Education
  • Health Information Exchange

Population Management

Implementation of episodic care management practice improvements

Provide episodic care management, including management across transitions and referrals that could include one or more of the following:

  • Routine and timely follow-up to hospitalizations, ED visits and stays in other institutional settings, including symptom and disease management, and medication reconciliation and management; and/or
  • Managing care intensively through new diagnoses, injuries and exacerbations or illness.

Medium

  • Health Information Exchange

Population Management

Implementation of medication management practice improvements

Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following:

  • Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups;
  • Integrate a pharmacist into the care team; and/or
  • Conduct periodic, structured medication reviews.

Medium

  • None

Care Coordination

Implementation or use of specialist reports back to referring clinician or group to close referral loop

  • Performance of regular practices that include providing specialist reports back to the referring MIPS eligible clinician or group to close the referral loop or where the referring MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the CEHRT.

Medium

  • Health Information Exchange

Care Coordination

Implementation of documentation improvements for practice/process improvements

  • Implementation of practices/processes that document care coordination activities (e.g. a documented care coordination encounter that tracks all clinical staff involved and communications from the date the patient is scheduled for an outpatient procedure through the day of the procedure).

Medium

  • Secure Messaging
  • Health Information Exchange

Care Coordination

Implementation of practices/

processes for developing regular individual care plans

  • Implementation of practices/processes to develop regularly updated individual care plans for at-risk patients that are shared with the beneficiary or caregiver(s).

Medium

  • Provide Patient Access
  • VDT
  • Secure Messaging

Care Coordination

Practice improvements for bilateral exchange of patient information

Ensure that there is bilateral exchange of necessary patient information to guide patient care that could include one or more of the following:

  • Participate in a Health Information Exchange if available; and/or
  • Use structured referral notes.

Medium

  • Health Information Exchange

Beneficiary Engagement

Use of certified EHR to capture patient reported outcomes

  • In support of improving patient access, performing additional activities that enable capture of patient-reported outcomes (e.g. home blood pressure) or patient activation measures through use of CEHRT, containing this date in a separate queue for clinician recognition and review.

Medium

  • Provide Patient Access
  • Patient-
  • Specific Education

Beneficiary Engagement

Engagement of patients through implementation of improvements in patient portal

  • Access to an enhanced patient portal that provides up-to-date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence.

Medium

  • Provide Patient Access
  • Patient-
  • Specific Education

Beneficiary Engagement

Engagement of patients, family and caregivers in developing a plan of care

  • Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the CEHRT.

Medium

  • Provide Patient Access
  • Patient-
  • Specific Education
  • VDT
  • Secure Messaging

Safety and Practice Assessment

Use of decision support and standardized treatment protocols

  • Use decision support and protocols to manage workflow in the team to meet patient needs.

Medium

  • None

Achieving Health Equity

Leveraging a QCDR to standardize processes for screening

  • Participation in a QCDR, demonstrating performance of activities for use of standardized processes for screening for social determinants of health such as food security, employment and housing. Use of supporting tools that can be incorporated in the CEHRT is also suggested.

Medium

Integrated Behavioral and Mental Health

Implementation of integrated PCBH model

Offer integrated behavioral health services to support patients with behavioral health needs, dementia, and poorly controlled chronic conditions that could include one or more of the following:

  • Use evidence-based treatment protocols and treatment to goal where appropriate;
  • Use evidence-based screening and case finding strategies to identify individuals at risk and in need of services;
  • Ensure regular communication and coordinated workflows between eligible clinicians in primary care and behavioral health;
  • Conduct regular case reviews for at-risk or unstable patients and those who are not responding to treatment;
  • Use of a registry or certified health information technology functionality to support active care management and outreach to patients in treatment; and/or
  • Integrate behavioral health and medical care plans and facilitate integration through co-location of services when feasible.

High

  • Provide Patient Access
  • Patient-
  • Specific Education
  • VDT
  • Secure Messaging

Integrated Behavioral and Mental Health

Electronic Health Record Enhancements for BH data capture

  • Enhancements to an electronic health record to capture additional data on behavioral health (BH) populations and use that data for additional decision-making purposes (e.g. capture of additional BH data results in additional depression screening for at-risk patient not previously identified).

Medium

  • Health Information Exchange

Data Validation
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.  

More information

  • For more information on the Improvement Activities performance category for MIPS, click here.
  • For more information on the ACI performance category for MIPS, click here.
  • To visit Practice Fusion’s Quality Payment Program Center, click here.

Quality Payment Program

  1. 2018 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  2. What is the MIPS Dashboard watch list and how do I use it?
  3. How does the MIPS Dashboard work?
  4. What is the Promoting Interoperability (formerly Advancing Care Information) performance category in MIPS?
  5. 2018 What is the Quality performance category in MIPS?
  6. 2018 What are Improvement Activities in MIPS?
  7. Which Improvement Activities qualify for the Promoting Interoperability performance category bonus in 2018?
  8. What is the Cost performance category of MIPS and how is it scored in 2018?
  9. How is the MIPS Final Score Calculated in 2018?
  10. What is a MIPS eligible clinician in 2018?
  11. MIPS for Small, Rural and Underserved Practices
  12. 2018 PI Transition Measure: Medication Reconciliation
  13. 2018 PI Transition Measure: Electronic Prescribing (eRx)
  14. 2018 PI Transition Measure: Secure Messaging
  15. 2018 PI Transition Measure: Security Risk Analysis
  16. 2018 PI Transition Measure: Health Information Exchange
  17. 2018 PI Transition Measure: Immunization Registry Reporting
  18. 2018 PI Transition Measure: Specialized Registry Reporting
  19. 2018 PI Transition Measure: Syndromic Surveillance Reporting
  20. 2018 PI Transitional Measure: View, Download, or Transmit (VDT)
  21. 2018 PI Transition Measure: Provide Patient Access
  22. 2018 PI Transition Measure: Patient-Specific Education
  23. What is the Practice Fusion QCDR?
  24. 2017 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  25. How do I report my 2017 MIPS data to CMS using the Practice Fusion QCDR?
  26. What is the Advancing Care Information (ACI) Performance Category for MIPS and how is it scored?
  27. 2017 ACI Transition Measure: Security Risk Analysis
  28. 2017 ACI Transition Measure: Electronic Prescribing (eRx)
  29. 2017 ACI Transition Measure: Provide Patient Access
  30. 2017 ACI Transition Measure: Health Information Exchange
  31. 2017 ACI Transition Measure: View, Download, or Transmit (VDT)
  32. 2017 ACI Transition Measure: Patient-Specific Education
  33. 2017 ACI Transition Measure: Secure Messaging
  34. 2017 ACI Transition Measure: Medication Reconciliation
  35. 2017 ACI Transition Measure: Immunization Registry Reporting
  36. 2017 ACI Bonus Measure: Syndromic Surveillance Reporting
  37. 2017 ACI Bonus Measure: Specialized Registry Reporting
  38. What is the Improvement Activities Performance Category for MIPS?
  39. What are the Quality performance category reporting requirements for MIPS?
  40. What is the difference between the two Advancing Care Information measure sets available in 2017?
  41. What are Alternative Payment Models (APMs) and Advanced APMs?
  42. What is Comprehensive Primary Care Plus (CPC+)?
  43. Which Improvement Activities Qualify for the Advancing Care Information (ACI) Bonus Score in 2017?
  44. How do I contact CMS about the Quality Payment Program?
  45. How do I indicate interest in the Practice Fusion QCDR and get my MIPS estimated scores?
  46. Chronic Care Management FAQs
  47. How do I export a JSON file for 2017 MIPS reporting?
  48. How is the MIPS Final Score Calculated in 2017?

Feedback and Knowledge Base