• MIPS 2018—PI: The 2018 Promoting Interoperability Transition Measure Set

    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


    A change to the name, but everything else stays the same. This measure set was previously known as the 2018 advancing care information (ACI) measure set. In April, CMS changed its name to the 2018 promoting interoperability (PI) transition measure set. CMS also has tweaked the codes for these measures. In the 2018 ACI transition measure set, for example, the code for the e-prescribing measure changes from ACI_TRANS_EP_1 to PI_TRANS_EP_1. Other than that, the measures are unchanged

    Your CEHRT determines which measures set you can report. If your EHR system is a 2014-certified CEHRT, you must select the 2018 PI transition measures set. If your EHR system is a 2015-certified CEHRT, you can choose to report either the 2018 ACI transition measures set or the PI measure set.

    There are 11 2018 PI transition measures:

    • 2 measures are strictly mandatory—and 1 of them also contributes to the performance score
    • 2 measures are mandatory, but you may be eligible for an exclusion—and 1 of them also contributes to the performance score
    • 7 measures are optional—5 of these contribute to the performance score; 2 can be used to earn the registry/agency bonus

    Base Score Measures

    Measure Required or Optional? Reporting Requirement
    Security Risk Analysis Strictly mandatory Yes/no statement*
    e-Prescribing Mandatory, with possible exclusion Numerator/denominator
    Provide Patient Access Strictly mandatory Numerator/denominator
    Health Information Exchange Mandatory, with possible exclusion Numerator/denominator
    All or nothing. If you successfully report (or claim an exclusion for) all 4 measures, your base score contributes 50% to your overall PI score. If you fall short, even by just 1 measure, your base score is 0% and your PI score is 0%.

    To successfully report a “Yes/No” measure, attest (“Yes”) that you performed the activities that the measure requires. If you attest “No,” you fail the measure. Make sure you document the activities that you performed.

    To successfully report numerator/denominator measures for the base score, you need a numerator of at least 1. For the e-Prescribing measure, for example, the denominator is the number of prescriptions written for drugs during the performance period and the numerator is the number of those prescriptions that were 1) generated, 2) queried for a drug formulary, and 3) transmitted using a CEHRT. For the base score, you need a numerator of at least 1 and you get no extra credit for a numerator that is more than 1.

    Performance Score Measures

    Measure Required or Optional? Contribution to PI Score Reporting Requirement
    Provide Patient Access Strictly mandatory Up to 20% Numerator/denominator
    Health Information Exchange Mandatory, with possible exclusion Up to 20% Numerator/denominator
    Patient-Specific Education Optional Up to 10% Numerator/denominator
    View, Download, or Transmit (VDT) Optional Up to 10% Numerator/denominator
    Secure Messaging Optional Up to 10% Numerator/denominator
    Medication Reconciliation Optional Up to 10% Numerator/denominator
    Immunization Registry Reporting Optional 0% or 10% Yes/no statement

    When reporting numerator/denominator measures for the performance score, your score will depend on your performance rate. For example, suppose you report the Patient-Specific Education measure. The denominator for that measure is the number of unique patients seen during the performance period. The numerator is the number of those patients (or their authorized representatives) who were given electronic access to patient-specific education based on clinically relevant information identified from your CEHRT. If the numerator was 200 and the denominator was 600, then your performance rate is 33.33% (200/600). This measure can contribute up to 10% to your PI score. Scoring is decile based, and a score of 31-40% would contribute 4% to your PI score.

    Alternative to reporting the Immunization Registry Reporting measure. Instead of reporting the Immunization Registry Reporting measure, you can earn 10% toward your performance score by actively engaging with a clinical data registry (e.g., the IRIS Registry) or public health agency and reporting 1 of the registry/agency bonus score measures, below. (See A New Way to Boost Your Performance Score.)

    Registry/Agency Bonus Score Measures

    Measure Required or Optional? Contribution to PI Score Reporting Requirement
    Syndromic Surveillance Reporting Optional 0% or 5% Yes/No Statement
    Specialized Registry Reporting Optional 0% or 5% Yes/No Statement

    Only need to report 1 measure for the bonus. Reporting 1 of these 2 measures earns you the full 5% bonus.

    Use the IRIS Registry. Integrating your EHR system with the IRIS Registry and using the dashboard appropriately will satisfy the Specialized Registry Reporting measure. However, if you used your engagement with the IRIS Registry to earn 10% toward your performance score (see A New Way to Boost Your Performance Score), you must use your engagement with a different registry to earn the 5% registry/agency bonus.

    How the measures contribute to your PI score. First, you must successfully report (or claim exclusions for) all the base score measures. If you do, your PI score = base score (50%) + performance score (0%-90%) + registry/agency bonus (0% or 5%) + CEHRT for improvement activities bonus + 2015-edition CEHRT bonus.

    Your PI score is capped at 100%, and it contributes up to 25 points to your 2018 MIPS final score (e.g., a PI score of 80% contributes 20 points).

    To view an at-a-glance PDF of these measures, see Table 15.

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    Previous: PI: Some Exceptions Are Automatic.

    Next: PI: The Promoting Interoperability Measure Set.

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