• MIPS 2018—Overview 2: Promoting Interoperability (Formerly ACI) Performance Category

    Written By: Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS

    This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page


    New name! The promoting interoperability (PI) performance category was previously known as advancing care information (ACI). CMS didn’t announce the name change until April 24, 2018, which was after EyeNet’s MIPS 2018: A Primer and Reference went to press. Because the name change occurred part way through the 2018 performance year, you can expect to see the old ACI terminology in most MIPS resources.

    Your EHR system must be a certified EHR technology (CEHRT). There are 2 types of certification: the 2014 edition and the 2015 edition.

    Exceptions: If a promoting interoperability (PI) exception applies to you, the composition of your MIPS final score will be reweighted (see Table 1: 2018 MIPS Final Score).

    Reporting at a Glance and Scoring Summary 

    The minimum performance period is 90 consecutive days. 

    There are 2 measure sets. If you have a 2014-edition CEHRT, you can use the 2018 PI transition measure set; if you have a 2015-edition CEHRT, you can choose to use either the PI measure set or the 2018 PI transition measure set.

    Pick how you’ll report PI measures. You can manually attest to performing PI measures via the IRIS Registry web portal. You’re other options are to attest via the CMS web portal or your EHR vendor.

    Five scores contribute to your PI score: Base score, performance score, and 3 bonus scores. Note: While CMS uses percentage points to express PI scores (e.g., base score of 50%), you will frequently see them ex­pressed as points (e.g., base score of 50 points).

    Add 5 Scores Together Contribution to PI Score
    (1) Base score 0% or 50%
    (2)performance score 0%-90%
    (3)registry/agency bonus score 0% or 5%
    (4)CEHRT for improvement activities bonus score 0% or 10%
    (5)2015-edition CEHRT bonus 0% or 10%
    = PI score 0%-100%
    Your PI score (0%-100%) contributes up to 25 points to your MIPS final score. For example, a PI score of 80% contributes 20 points.

    (1) Base Score 

    Base score (0% or 50%) is mandatory. If your base score is 0%, your entire PI score is 0%.

    Base score is all or nothing. To get the full 50%, you must report (or claim an exclusion for) all 4 base score measures from the 2018 PI transition measure set or all 5 from the PI measure set; if you fall short, you get 0%. Two of the 2018 PI transition measures and 3 of the PI measures have exclusions.

    The reporting threshold for the base score is fairly low. For the Security Risk Analysis measure, you must report that you performed the analysis; for the other base score measures, report a numerator of at least 1.

    (2) Performance Score

    Performance score (0%-90%) is based on your performance rate for the measures that you report. For instance, the Patient-Specific Education measure can contribute 0%-10% to your PI performance score. If you meet that measure’s requirements for 33% of applicable patients, you would score 4% for that measure.

    Mandatory or optional? Most performance score measures are optional, but some of them are also base score measures and are therefore required. However, CMS has added exclusions for some “required” measures. For example, if you seldom refer or transfer patients, you may be excluded from the Health Information Exchange measure.

    New: Instead of reporting the Immunization Registry Reporting performance score measure, you can engage with a public health agency or clinical data registry (see A New Way to Boost Your Performance Score).

    (3, 4, 5) Three Bonus Scores

    Registry bonus score (0% or 5%). You can get a 5% bonus if you report to a registry or public health agency.

    CEHRT for improvement activities bonus score (0% or 10%). Earn this bonus if you use CEHRT functionality for an improvement activity.

    2015-edition CEHRT bonus (0% or 10%). Earn this bonus if you report the PI measure set using only the 2015-edition CEHRT

      2018 PI Transition Measure Set PI Measure Set
    Number of measures: 11 measures 15 measures
    Strictly mandatory: 2 base score measures (1 of these also is a performance score measure) 2 base score measures (1 of these also is a performance score measure)
    Mandatory, possible exclusion: 2 base score measures (1 of these also is a performance score measure) 3 base score measures (2 of these also are performance score measures)
    Optional: 5 performance score measures, 2 registry/agency bonus measures 6 performance score measures, 4 registry/agency bonus measures
    Can be reported using: 2014- or 2015-edition CEHRT or a mixture of the 2 if using modular approach 2015-edition CEHRT or a mixture of 2014- and 2015- edition CEHRT modules

    Want to know more about the promoting interoperability? See How to Report Promoting Interoprability, beginning with Getting Started With Promoting Interoperability (formerly ACI): CEHRT, 2 Measure Sets, and Different Levels of Participation.

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    Previous: Overview 1: The Quality Performance Category.

    Next: Overview 3: The Improvement Activities Performance Category.

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