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Quality Payment Program: Advancing Care Information Performance Category: Part 1

Hess, Cathy Thomas BSN, RN, CWCN

Advances in Skin & Wound Care: May 2017 - Volume 30 - Issue 5 - p 240
doi: 10.1097/01.ASW.0000515787.03552.8e
Departments: Practice Points

Cathy Thomas Hess, BSN, RN, CWCN, is Vice President and Chief Clinical Officer for Wound Care, NET Health. Ms Hess presides over Net Health 360 WoundExpert Professional Services, which offers products and solutions to optimize process and workflows. Address correspondence to Ms Hess via e-mail: chess@nethealth.com.

Continuing our focus on the Merit-based Incentive Program System (MIPS), we are reminded that there are 4 areas that affect how you will be paid by Medicare, namely, Quality, Clinical Practice Improvement Activities (referred to as “Improvement Activities”), Certified Electronic Health Record Technology ([CEHRT] referred to as “Advancing Care Information”), and Resource Use (referred to as “Cost”). In this column, we will focus on the Advancing Care Information. The following information is directly excerpted from the Quality Payment Program’s Advancing Care Information Performance Category Fact Sheet.1

For scoring purposes, in the Advancing Care Information Performance Category (weighted at 25% of the total score), MIPS-eligible clinicians may earn a maximum score of up to 155%, but any score greater than 100% will be capped at 100%. This structure was deliberately created to ensure that clinicians have flexibility to focus on measures that are the most relevant to them and their practices.

The Advancing Care Information score is the combined total of the following 3 scores:

* required base score = 50%

* performance score = up to 90%

* bonus score = up to 15%

The performance score and bonus score are added to the base score to get the total Advancing Care Information Performance Category score. The total Advancing Care Information Performance Category score will then be multiplied by the 25% Advancing Care Information category weight with the result adding to the overall MIPS final score.

Clinicians who are MIPS eligible must use CEHRT to report to the Advancing Care Information Performance Category. If they do not have a certified electronic health record, they must meet certain criteria in order to qualify for a reweighting of the performance category to 0%, so that it is not included in the total score. Simply lacking CEHRT is not sufficient to qualify to have the Advancing Care Information Performance Category weight to be set at 0% of the MIPS final score.

A MIPS-eligible clinician’s performance score may be reweighted for the following reasons:

1. They apply for reweighting, citing 1 of 3 specified reasons:

* insufficient internet connectivity

* extreme and uncontrollable circumstances

* lack of control over the availability of CEHRT

These MIPS-eligible clinicians must submit an application for CMS to reweight the Advancing Care Information Performance Category to 0%. More information about the application will be available in 2017.

2. They are one of the following MIPS-eligible clinicians who qualify for an automatic reweighting:

* hospital-based MIPS clinicians

* physician assistants

* nurse practitioners

* clinical nurse specialists

* certified registered nurse anesthetists

* clinicians who lack face-to-face interactions with patients

These MIPS-eligible clinicians can still choose to report if they wish, and if data are submitted, the CMS will score their performance and weight their Advancing Care Information performance accordingly. For these 2 groups of MIPS-eligible clinicians, the CMS will reweight the category to 0% and assign the 25% to the Quality performance category to maintain the potential for participants to earn up to 100 points in the MIPS final score.

In 2017, there are 2 measure set options for reporting:

* Advancing Care Information objectives and measures

* 2017 Advancing Care Information transition objectives and measures

The option you will use to send in data is based on your CEHRT edition.

Clinicians who are MIPS eligible can report the Advancing Care Information objectives and measures if they have

* technology certified to the 2015 edition or

* a combination of technologies from the 2014 and 2015 editions that support these measures.

In 2017, MIPS-eligible clinicians can alternatively report the 2017 Advancing Care Information transition objectives and measures if they have

* technology certified to the 2015 edition or

* technology certified to the 2014 edition or

* a combination of technologies certified to the 2014 and 2015 editions.

In the next column, we will look at how the base, performance, and bonus scores are calculated. Document diligently!

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Reference

1. Centers for Medicare & Medicaid Services. Advancing Care Information Performance Category Fact Sheet. https://qpp.cms.gov/docs/QPP_ACI_Fact_Sheet.pdf. Last accessed March 26, 2017.
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