Skip to main content

ACO / APM Performance Pathway (APP) Registry

Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) are required to report the Alternative Payment Model (APM) Performance Pathway (APP) Plus quality measure set via the APP to meet the quality performance standard used to determine shared savings and shared losses.

ACOs can report quality data through the APP and can choose to actively report eCQMs, MIPS CQMs, or Medicare CQMs. ACOs may choose a submission method that best meets their specific needs (e.g., direct, login and upload, or a third-party intermediary). This means ACOs could choose a CMS Qualified Registry like MDinteractive to report quality data to CMS on their behalf.

Required Quality Measures for 2026

ACOs must report 5 eCQMs / MIPS CQMs / Medicare CQMs:

  1. #1 Diabetes: Glycemic Status Assessment Greater Than 9%
  2. #112 Breast Cancer Screening
  3. #113 Colorectal Cancer Screening
  4. #134 Preventive Care and Screening: Screening for Depression and Follow-Up Plan
  5. #236 Controlling High Blood Pressure

In addition:

  • ACOs must field the CAHPS for MIPS Survey (#321), administered by a third-party intermediary.
  • CMS will calculate the Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate (#479) using administrative claims data.
  • Note: PY 2026 is the last year ACOs will have the option to report MIPS CQMs as part of the APP Plus quality measure set.

Scoring & Data Requirements

ACOs will receive a score of 1 to 10 points for each measure that meets:

  • Data completeness: submitted data for at least 75% of the denominator eligible patients/instances
  • Case minimum: at least 20 cases

Scores are determined by comparing measure performance to established benchmarks.

Quality Performance Standard (PY 2026)

The quality performance standard is the minimum quality performance ACOs must achieve to be eligible to share in savings at the maximum rate available for the ACO's track.

The quality performance standard for PY 2026 is based on averaging the 40th percentile MIPS quality performance category scores from PY 2022 through PY 2024, which are set from the unweighted distribution of all MIPS quality performance category scores, excluding entities and providers eligible for facility-based scoring. The 40th percentile MIPS quality performance category score used for the PY 2026 quality performance standard is 73.85.

Three Pathways to Meet the Standard

ACOs that report the APP Plus quality measure set can meet the quality performance standard via one of three pathways:

  1. For all ACOs: Achieve a quality score that is equivalent to or higher than the 40th percentile across all MIPS quality performance category scores, excluding entities/providers eligible for facility-based scoring.
  2. For ACOs that report the five eCQMs/MIPS CQMs and meet the MIPS data completeness requirement for all five measures: Meet the eCQM/MIPS CQM reporting incentive by achieving a quality performance score equivalent to or higher than the 10th percentile of the performance benchmark on at least one of the four outcome measures in the APP Plus quality measure set, and a quality performance score equivalent to or higher than the 40th percentile of the performance benchmark on at least one of the remaining seven measures in the APP Plus quality measure set.
  3. For ACOs in their first performance year of their first agreement period under the Shared Savings Program: Report the APP Plus quality measure set and meet the MIPS data completeness requirement on the five eCQMs/MIPS CQMs/Medicare CQMs in the APP Plus quality measure set, administer the CAHPS for MIPS Survey (except if the ACO does not meet the minimum beneficiary sampling requirements specified at 42 CFR § 414.1380(b)(1)(vii)(B)), and receive a MIPS quality performance category score.

Alternative Quality Performance Standard

ACOs that do not meet the quality performance standard can meet the alternative quality performance standard to be eligible to share in savings at a lower rate that is scaled based on the ACO's quality performance. To meet the alternative quality performance standard, the ACO must report quality data on the APP Plus quality measure set and achieve a quality performance score equivalent to or higher than the 10th percentile of the performance benchmark on at least one of the four outcome measures in the APP Plus quality measure set.

How MDinteractive Can Help

  • Assistance with compliance: MDinteractive can help ACOs comply with the data reporting requirements while supporting your ability to make informed decisions on how best to improve the quality of care for Medicare patients within your organization.
  • One-stop reporting for required Quality eCQMs and CQMs: Measures #1, #112, #113, #134, and #236 can be reported via MDinteractive.
  • Flexible data input: MDinteractive can accept various types of quality data files and also provides software "tools" that can be used to build quality reports.
  • Flexible submission choices: MDinteractive can accommodate data at the ACO level, by participating TIN, or at the individual clinician level.
  • Monitoring performance: MDinteractive software allows you to plan, track and optimize your quality data reporting and performance through an interactive dashboard. You will have the ability to monitor your performance at the ACO, TIN, and clinician level throughout the year and make necessary quality improvements within your organization to maximize your incentive payments.
  • Responsiveness to changes within your organization: MDinteractive has extensive experience aggregating quality data from multiple EHRs before submission to CMS.
  • Hands-on customer support at all stages in the reporting process: At MDinteractive, our seasoned team will help you navigate through the reporting process from beginning to end and offer advice on how to maximize your reimbursement and avoid sharing losses.

If you are participating in the program, contact us today to discuss how we can help you meet the annual Quality reporting requirements. We offer flexible data collection options to make tracking and reporting these measures a simple process for you and your practice.

Check out this blog for more information.

Schedule an MDinteractive ACO Reporting Demo

CMS Resources & Documents

APP Data Submission & Reporting

APP Toolkit

Quality Performance Standard

Promoting Interoperability