MVP ID: M0005
Most applicable medical specialty(s):
Preventive Medicine, Internal Medicine, Family Medicine, Geriatrics
The Value in Primary Care MVP focuses on the clinical theme of promoting quality care for patients in order to reduce the risk of diseases, disabilities, and death.
Quality
Report 4 quality measures (one must be an outcome or a high priority measure):
- Quality ID: 001 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
- Quality ID: 047 - Advance Care Plan
- Quality ID: 134 - Preventive Care and Screening: Screening for Depression and Follow-Up Plan
- Quality ID: 236 - Controlling High Blood Pressure
- Quality ID: 305 - Initiation and Engagement of Substance Use Disorder Treatment
- Quality ID: 321 - CAHPS for MIPS Clinician/Group Survey
- Quality ID: 438 - Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
- Quality ID: 475 - HIV Screening
- Quality ID: 483 - Person-Centered Primary Care Measure Patient Reported Outcome Performance Measure (PCPCM PRO-PM)
- Quality ID: 487 - Screening for Social Drivers of Health
- Quality ID: 493 - Adult Immunization Status
- Quality ID: 497 - Preventive Care and Wellness (composite)
- Quality ID: 504 - Initiation, Review, And/Or Update To Suicide Safety Plan For Individuals With Suicidal Thoughts, Behavior, Or Suicide Risk
Improvement Activities
Report Two medium-weighted improvement activities or One high- weighted improvement activity:
- Activity ID: IA_AHE_12 - Practice Improvements that Engage Community Resources to Address Drivers of Health
- Activity ID: IA_AHE_3 - Promote Use of Patient-Reported Outcome Tools
- Activity ID: IA_AHE_9 - Implement Food Insecurity and Nutrition Risk Identification and Treatment Protocols
- Activity ID: IA_BE_12 - Use evidence-based decision aids to support shared decision-making
- Activity ID: IA_BE_4 - Engagement of patients through implementation of improvements in patient portal
- Activity ID: IA_BE_6 - Regularly Assess Patient Experience of Care and Follow Up on Findings
- Activity ID: IA_CC_13 - Practice Improvements to Align with OpenNotes Principles
- Activity ID: IA_CC_2 - Implementation of improvements that contribute to more timely communication of test results
- Activity ID: IA_EPA_1 - Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record
- Activity ID: IA_MVP - Practice-Wide Quality Improvement in MIPS Value Pathways
- Activity ID: IA_PCMH - Electronic submission of Patient Centered Medical Home accreditation
- Activity ID: IA_PM_11 - Regular review practices in place on targeted patient population needs
- Activity ID: IA_PM_13 - Chronic Care and Preventative Care Management for Empaneled Patients
- Activity ID: IA_PM_16 - Implementation of medication management practice improvements
- Activity ID: IA_PM_22 - Improving Practice Capacity for Human Immunodeficiency Virus (HIV) Prevention Services
- Activity ID: IA_PM_23 - Use of Computable Guidelines and Clinical Decision Support to Improve Adherence for Cervical Cancer Screening and Management Guidelines
Cost
Calculated by CMS using administrative claims data:
- Measure ID: COST_ACOPD_1 - Asthma/Chronic Obstructive Pulmonary Disease (COPD)
- Measure ID: COST_D_1 - Diabetes
- Measure ID: COST_DEP_1 - Depression
- Measure ID: COST_HF_1 - Heart Failure
- Measure ID: TPCC_1 - Total Per Capita Cost (TPCC)
Population Health Measures
Select one population health measure to be scored by CMS using administrative claims data:
- #479: Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-Based Incentive Payment Program (MIPS) Groups (Administrative Claims)(!!)
- #484: Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (Administrative Claims) (!!)
Promoting Interoperability
Report on the same PI measures required under traditional MIPS unless qualified for automatic reweighting or approved hardship exception:
- Prevention of Information Blocking
- e-Prescribing
- Query of the Prescription Drug Monitoring Program (PDMP) (Optional)
- Provide Patients Electronic Access to Their Health Information
- Support Electronic Referral Loops By Sending Health Information AND
- Support Electronic Referral Loops By Receiving and Reconciling Health Information OR
- Health Information Exchange (HIE) Bi-Directional Exchange
- Enabling Exchange Under the Trusted Exchange Framework and Common Agreement (TEFCA)
- Immunization Registry Reporting
- Syndromic Surveillance Reporting
- Electronic Case Reporting
- Public Health Registry Reporting
- Clinical Data Registry Reporting
- Security Risk Analysis
- Safety Assurance Factors for EHR Resilience Guide (SAFER Guide)
- ONC Direct Review
MVP Registration
- MVP Participants must register between April 1 – December 2, 2024 to report an MVP in 2024.
- To register, MVP Participants must select:
- The MVP they intend to report.
- 1 population health measure included in the MVP.
- Any outcomes-based administrative claims measures on which the MVP Participant intends to be scored (if available).
- If reporting as a subgroup, registration must also include:
- A list of Taxpayer Identification Numbers (TINs)/National Provider Identifiers (NPIs) in the subgroup;
- A plain language name for the subgroup (which will be used for public reporting);
- A description of the composition of the subgroup, which may be selected from a list or described in a narrative.
- MVP Participants won’t be able to:
- Submit/make changes to the MVP they select after the close of the registration period (December 2, 2024).
- Report on an MVP they didn’t register for during the 2024 performance year.
- Report on more than one MVP.