MIPS Improvement Activities Component

The Improvement Activities performance category of MIPS aims to reward eligible clinicians and groups for engaging in clinical practice improvement activities such as care coordination, beneficiary engagement and patient safety. Improvement Activities account for 15% of the total MIPS Composite Score in performance year 2019 and beyond.

CMS has finalized a list of 117 activities for the 2019 reporting year. Each individual improvement activity is assigned a weight of either medium or high. Medium weighted activities receive 10 points and high weighted activities receive 20 points. To receive full credit, eligible clinicians must receive a score of 40 points.

CMS offers two exceptions to this point structure:

  • Eligible clinicians participating in MIPS APMs will receive the equivalent of the base score of 40 points for this component.
  • Small practices, rural practices, or practices located in geographic health professional shortage areas (HPSAs), and non-patient facing MIPS eligible clinicians will have their medium weighted activities count for 20 points and their high weighted activities count for 40 points. They will still be required to reach 40 points to receive full credit for this component.

Eligible clinicians and their practices may report Improvement Activities, either as individuals or as a group practice, via Attestation, Qualified Clinical Data Registry (QCDR), Qualified Registry, Electronic Health Record (EHR) or CMS Web Interface (groups of 25+).

ASA has developed a downloadable list of Recommended Improvement Activities for Anesthesiologists and Pain Medicine Physicians (pdf). ASA has developed downloadable documentation guidance for 12 of the recommended Improvement Activities for anesthesiologists and pain medicine physicians.

For information on the 2017 and 2018 QPP, visit the QPP Resource Library site.

More MIPS Components

You can also find CMS Resources here and ASA FAQs here for all things MACRA.