MIPS: Explaining the Improvement Activities Performance Category

MIPS: Explaining the Improvement Activities (IA) Performance Category

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Under the Medicare Access and CHIP Reauthorization Act (MACRA), which was passed and signed into law in April 2015, eligible clinicians (ECs) will participate in either the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (AAPM). MIPS and AAPMs are collectively referred to as the Quality Payment Program (QPP).

With the MIPS track, ECs receive a final score based on performance in four performance categories: quality, cost, promoting interoperability (PI), and improvement activities.

Improvement Activities Reporting

The improvement activity category is a new performance category in MIPS and contains activities which are similar to the functions of a patient-centered medical home (PCMH). The activities are designed to improve clinical practice or care delivery that, when effectively executed, lead to improved outcomes.

Eligible clinicians (ECs) must report from a list of improvement activities(qpp.cms.gov). Activities must be performed for a minimum of 90 consecutive days during the reporting period.

Activities are either medium-weighted (10 points) or high-weighted (20 points). ECs must report on four medium-weighted activities, two high-weighted activities, or a combination of both to earn up to 40 points.

Eligible clinicians in small (less than 15 clinicians), rural, or health professional shortage areas (HPSAs) will receive double points for each activity, and will need to report either two medium-weighted activities or one high-weighted activity to earn 40 points.

Certain activities can earn bonus points in the PI category.

Eligible clinicians can report using an electronic health record (EHR), qualified registry, qualified clinical data registry (QCDR), CMS Web Interface, or via attestation.  

Improvement Activities Scoring

Eligible clinicians in a practice that has received PCMH recognition from the following organizations will receive full credit:

  • National Committee on Quality Assurance (NCQA)
  • The Joint Commission (TJC)
  • URAC
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • Accrediting bodies that have certified 500 or more practices

Practices and ECs will attest that they are a recognized PCMH. At least 50% of practice sites within a tax identification number (TIN) must be recognized as a PCMH for the entire TIN to receive full improvement activities credit.

Eligible clinicians in a Merit-based Incentive Payment System Alternative Payment Model (MIPS APM) will receive credit based on the requirements of the MIPS APM compared to the MIPS improvement activities requirements.

Eligible clinicians in an APM will automatically receive half credit (20 points).

To calculate the improvement activities category score, divide the points earned by the maximum points available (40). Take that score and multiply it by 0.15. The improvement activity category score is weighted at 15%.

Here is a breakdown (both in bullet and table form) of improvement activities credit earned by participation type:

  • Eligible clinicians = 40 (maximum points possible)
  • Certified PCMH = 40 (full credit if at least 50% of practice sites within a TIN are certified as a PCMH)
  • MIPS APM = To be scored by CMS
  • APM = 20 (automatic half credit)

Improvement Activities Participation

Eligible Clinicians

Certified PCMH

MIPS APM

APM

Improvement Activities Credit

40

Full credit (40)

Scored by CMS

Automatic ½ credit (20)