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Quality: APP Requirements

Overview

This performance category measures healthcare-related processes, outcomes, and patient experiences.

Requirements may change each  due to policy changes.

Select Performance Year

Performance Year

Select your performance year.

PY 2022 APP Quality Requirements

50% OF FINAL SCORE

This percentage can change due to Special Statuses, Exception Applications, or reweighting of other performance categories.

What Quality Data Submission Options are Available?

You have two options for what  to use for your APM Performance Pathway quality submission depending on your participation level.

If you participate at this level...You can use this collection type set...
Individual, Group, APM Entity (SSP ACO and non-SSP ACO)Option 1
  • eCQM, MIPS CQM, or Medicare Part B Claims* (3 measures),
  • CAHPS for MIPS and;
  • Administrative Claims (2 measures).
APM Entity (SSP ACOs only)Option 2
  • CMS Web Interface (10 measures),
  • CAHPS for MIPS and;
  • Administrative Claims (2 measures).

*Only individuals, groups and APM Entities with the small practice designation can report Medicare Part B claims measures.

What Quality Data Should I Submit?

You must collect measure data for the 12-month  (January 1 - December 31, 2022) on one of the following sets of pre-determined quality measures:

Measure # and Title

Collection Type Submitter Type

Quality ID: 001
Diabetes: Hemoglobin A1c 
(HbA1c) Poor Control

eCQM, MIPS CQM,
Medicare Part B 
Claims

MIPS Eligible Clinician Representative of a Practice APM Entities Third Party Intermediary
Quality ID: 134
Preventive Care and Screening:
Screening for Depression 
and Follow-up Plan
eCQM, MIPS CQM,
Medicare Part B 
Claims
MIPS Eligible Clinician Representative of a Practice APM Entities Third Party Intermediary
Quality ID: 236
Controlling High Blood Pressure
eCQM, MIPS CQM,
Medicare Part B 
Claims
MIPS Eligible Clinician Representative of a Practice APM Entities Third Party Intermediary
Quality ID: 321
CAHPS for MIPS
CAHPS for MIPS Survey Third Party Intermediary
Measure #: 479
Hospital-Wide, 30-day, 
All-Cause Unplanned
Readmission (HWR) Rate
for MIPS Eligible MIPS 
Clinician Groups
Administrative Claims N/A

Measure #: 484
UPDATED: Clinician and 
Clinician Group Risk-
standardized Hospital 
Admission Rates for Patients 
with Multiple Chronic 
Conditions

Administrative Claims

N/A

Download Option 1: Quality Measures Set 

Measure # and Title Collection Type Submitter Type
Quality ID: 001
Diabetes: Hemoglobin A1c (HbA1c) 
Poor Control
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 134
Preventive Care and Screening: 
Screening for Depression and 
Follow-up Plan
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 236
Controlling High Blood Pressure
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 318
Falls: Screening for Future Fall Risk
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 110
Preventive Care and Screening: Influenza Immunization
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 226
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 113
Colorectal Cancer Screening
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 112
Breast Cancer Screening
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 438
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 370
Depression Remission at Twelve Months
CMS Web Interface APM Entities (SSP ACO)
Quality ID: 321
CAHPS for MIPS
CAHPS for MIPS Survey Third Party Intermediary
Measure #: 479
Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups
Administrative Claims N/A
Measure #: 484
UPDATED: Clinician and Clinician Group 
Risk-standardized Hospital Admission 
Rates for Patients with Multiple Chronic 
Conditions
Administrative Claims N/A

Download Option 2: Quality Measures Set 

CAHPS for MIPS

 for MIPS is a required measure for the APM Performance Pathway.

APM Entities (SSP ACOs) will not need to register for CAHPS. However, these APM Entities (SSP ACOs) must hire a vendor.

APM Entities (non-SSP ACOs) that choose to report the CAHPS for MIPS Survey will need to register during the open registration period. If you register for the CAHPS for MIPS Survey, you will need to hire a vendor to administer the survey for you.

If your APM Entity (non-SSP ACO) only reports Traditional MIPS, reporting the CAHPS for MIPS measure is optional.

Practices (groups) reporting through the APM Performance Pathway must register for the CAHPS for MIPS survey.

The CAHPS for MIPS survey is not available to clinicians reporting the APM Performance Pathway as an individual.

Learn more and register for the CAHPS for MIPS survey

EHR-based Quality Reporting

If you transition from one  system to another during the performance year, you should aggregate the data from the previous EHR and the new EHR into one report for the full 12 months prior to submitting the data. If a full 12 months of data is unavailable (for example if aggregation is not possible), your data completeness must reflect the 12-month period. If you are submitting eCQMs, both EHR systems must be 2015 Edition  .

How Are Measures Scored?

If a measure can be reliably scored against a , it means:

  • A benchmark is available; and
  • The volume of cases you’ve submitted is sufficient (20 cases for most measures; 200 cases for the hospital readmission measure, 18 cases for the multiple chronic conditions measure); and
  • You’ve met data completeness requirements (submitted data for at least 70 % of the denominator eligible patients/instances).

Bonus Points

Six bonus points are added to the Quality performance category score for clinicians who submit at least 1 APP quality measure. This bonus is not added to clinicians or groups who are scored under facility-based scoring.

You can also earn up to 10 additional percentage points based on your improvement in the Quality performance category from the previous year.