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Alright alright alright! We made it to Part 4. Phew!!! As hopefully you know by now, in Part 1 of this series, we discussed the Basics of MIPS Scoring, and in Part 2, we discussed scoring for the Quality category. In Part 3, we discussed Improvement Activities scoring. Today, in our big series finale, Part 4, we’ll cover Advancing Care Information (ACI) scoring, plus an overview of the MIPS final score and payment adjustment calculation. And, away we go!

The Basics of Scoring the Advancing Care Information Category

One note before we hop into the weeds of scoring ACI. There are many exceptions to reporting ACI, so be sure to investigate those in case one applies to you or your group. The ACI exceptions are sometimes also called “ACI reweighting” because your overall score will be reweighted if one of those exceptions applies. See page three of this guide for a good resource to learn more. But, for the purposes of this post, let’s assume that you are required to report the ACI category and therefore, your MIPS score has not been reweighted.

Your overall ACI score has three parts, and each part is weighted differently. We have:

1. The base score, which is weighted at 50% of your total ACI score;
2.The performance score, which is weighted up to 90% of your total ACI score; and,
3.The bonus score, which is weighted up to 15% of your total ACI score.

If combining your scores in each of these parts results in a score higher than 100 points, you’ll automatically get full credit for the ACI category of MIPS. Now let’s look at each part in turn.

ACI Base Score: Required, and Worth 50% of Your Total ACI Score

In order to earn any points for the ACI category, you must successfully report the base score measures. But, luckily, successfully reporting the base score measures is relatively straightforward. To do so, you must:

1. Submit a “yes” answer for the security risk analysis measure; and
2. Submit at least a “1” in the numerator and denominator for the rest of the base score measures, indicating that you completed that measure at least once during the reporting period.  

The base score measures consist of either 4 or 5 measures, depending on what edition your electronic health record (EHR) is. To find out which EHR edition you use, visit here and then here. Depending on your EHR edition, here are the two separate sets of measures that you can report on:

Again, as long as you submit a yes to the security risk analysis measure, and at least 1 for the numerator and denominator for each other measure in your applicable base measure set, then you’ll get the full base score points. Easy, right? Let’s look at the performance score.

ACI Performance Score: Optional, but Worth Up to 90%

For the performance score part of ACI, you can choose the number of measures to report, with the maximum number dependent on the measure set you are reporting. Your measure set choice will be the same as it was for the base score, so no need to re-determine that for the performance score. Here are the two measure set reporting options, with corresponding measures:

For most measures, you will report a number for both a numerator and a denominator. With some nuance, the denominator is the number of times your practice could have performed a certain act, and the numerator is the number of times your practice actually did perform that act.  A performance rate is then calculated for each measure, based on the numerator and denominator. That performance rate is used to determine how many points you will receive for each measure, with most measures being worth 10% of the performance score (see above chart for each measure’s worth). The better your performance rate, the higher your score, as illustrated here:

Add up each of the points from these measures, and you’ll have your performance score for the ACI category.

ACI Bonus Score: Optional, and Worth Up to 15%

Last but not least, we’ve got the ACI bonus score. There are two ways you can earn bonus score points:

1. Indicating “yes” to reporting to public health and clinical data registries beyond the immunization registry reporting measure. Doing so earns you a 5% bonus.
2. Indicating “yes” that you completed 1 of your improvement activities using certified EHR technology. Doing so earns you a 10% bonus.

If you complete either one of these activities, you will receive bonus points for your bonus points score.

Each of these individual scores is then added up to get your total ACI score. As mentioned above, if each part of your score adds up to more than 100%, you’ll automatically get full credit for the ACI category, which is worth 25% of your overall MIPS score.

The Final Score and Payment Adjustment

Ok, the finish line is in sight!! We’ve reviewed scoring for each of 2017’s weighted MIPS categories, so now let’s take a look at how all that comes together to determine the  most important factor: your payment adjustment.

Once CMS determines your score from each of the categories, each score is then weighted accordingly, then added up and multiplied by 100 to get a your final score, which will be between 0 and 100.

Your score then corresponds to your payment adjustment, along the following scale:

The amount of the payment adjustment itself will depend on how other eligible clinicians perform because the amount of the payment adjustment is scaled. But, if you do exceptionally well - aka higher than 70 points - you can receive an exceptional performance bonus, in addition to the standard bonus. The amount of the exceptional bonus will also depend on how many other eligible clinicians score about 70 points.

And that, ladies and gentlemen, is IT! That is how CMS will calculate you MIPS score and corresponding payment adjustment. Easy, right? Well, if not easy, I hope, at this point, MIPS scoring is at least clearer than mud. But, if it isn’t - or if you are interested in learning more about pMD’s suite of products which includes MIPS Registry, charge capture, secure messaging, and care coordination software and services - please contact pMD. We’d love to hear from you!


Quality Payment Program Merit-based Incentive Program (MIPS) Scoring Guide 101 for the 2017 Performance Period, available at

Advancing Care Information Measure Specifications, available for download in a zip file at

Image: Proteus Digital Health

Here's The Latest in Health Care:

•  Who will be replacing Tom Price as the next Secretary of Health and Human Services (HHS)? Alex Azar, former pharmaceutical executive at Eli Lilly and former HHS general counsel and deputy secretary, is the President's nomination for the next head of HHS. Some major goals Azar will be tasked with, if confirmed, is the lowering of drug prices and implementing deregulation.  Read More

•  The Food and Drug Administration (FDA) has approved the first drug with a sensor that transmits data to a smartphone app, notifying whether someone has taken it. The tiny sensor is about the size of a grain of sand and is embedded into the pill, serving as a digital ingestion tracking system.  The sensor will detect and record the date and time the pill was ingested.  Read More

•  In the first 11 days of's open enrollment period, signups totaled nearly 1.5 million. Some experts suggest that with the push for the Affordable Care Act (ACA) repeal, the heightened visibility of the health care law is actually driving the increase in signups for the ACA exchange plans.  Read More

•  Scientists have found that a rare genetic mutation in Amish people living in a rural part of Indiana actually protects them from Type 2 diabetes and provides life-extending benefits.  The new findings could lead to new therapies for chronic diseases.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

I recently celebrated my 10-year anniversary at pMD. 10 years at the same company is becoming a rarity in the software industry. Yet my dad, Dan Kenney, worked for 40 years for the same architecture firm. 40 years! It sounds like an old-timey tale, a story about the Company Man. I began to wonder what about his company could have possibly held his attention for so long - it must have been quite an amazing institution.

But many others at his company came and went over the years, so maybe it was him rather than the company itself. Did he lack imagination? He’d been very successful and could have retired earlier, yet he kept chugging away and taking on greater responsibilities. I think he was genuinely happy there, and he didn’t feel a need or desire to move.

I began to wonder if the anomaly is not him or his company, but rather the software industry. It began to seem strange that Amazon has a 1-year median tenure and Google has a 1.1-year median tenure, both in the bottom 5 of the Fortune 500 according to PayScale for this measurement. If these companies are admired and successful, why aren’t their employees sticking around?

There are many good reasons to leave a company. The top reason given is greater opportunity for career advancement elsewhere. In other words, there is a lack of mentorship and growth at the old company. Now, the same companies that failed to offer in-place growth opportunities are adapting to their job-hopping employees:

"Hiring managers worry they’ll become the next victims of these applicants' hit-and-run job holding. For companies, losing an employee after a year means wasting precious time and resources on training & development, only to lose the employee before that investment pays off.” - Jeanne Meister, Forbes

But by reducing training and mentorship, wouldn’t they further decrease the opportunity for in-place career growth? They aren't expecting employees to stay around for a long time, so they’re not investing in their people, instead focusing on making their jobs more specific and interchangeable - like a “code factory” where a new assembly line worker can easily be slotted into a vacant position.

I don’t know whether companies or employees started this vicious cycle, and perhaps it makes sense in an increasingly commoditized industry that is dominated by a few huge near-monopolies. And I’ve met my share of counter-examples even at these companies, “lifers” who have stuck around for a long time and have no intention to leave. So there’s a ray of hope: if the fit is right, and the position has room to grow, then career bliss can still occur - even in today’s bleak landscape. So then, how to find the right long-term fit for you?

While researching this question, I found many different answers. A romantic advice blog said it best:

“When you know what you want, everything else becomes trivial. The better you understand yourself, the more experience you have and the clearer the life you want becomes. When we learn more and more about ourselves throughout our lifetimes, we come to a point of clarity. We come to a point at which we know what we want, and we know what we have to do to get it.”

I think self-knowledge was the key to my dad’s 40-year happy place. He knew what he wanted to achieve in his career and what kind of culture he needed to be successful, and he worked ceaselessly towards both. He didn’t bail when times got tough because he knew what he wanted, and he knew that his company was the right place where he could forge that vision into reality regardless of any setbacks along the way.

Dan Kenney

Self-knowledge sounds great. If only they sold it on Amazon! Some people seem to be “old souls,” born with more of it. Unfortunately for the rest of us, it’s generally hard-won. Most people gain self-knowledge by making mistakes and learning from those mistakes. Indeed, embracing failure is the approach most commonly recommended in tech. This is a very effective way to learn, but not a very efficient way because there are so many possible mistakes. Even if you learn from each mistake that you make, there are countless other varieties just around the next corner lying in wait for you. You’ll never live long enough to make all the mistakes.

Fortunately, you can also gain self-knowledge in other ways. You can ask experienced and successful people for advice, or read books written by wise people, and benefit from their mistakes without having to make the same mistakes yourself. You can pursue meditation or counseling to gain greater awareness of your own biases, blind spots, and true desires.

For example, would you enjoy the rollercoaster ride of a high-risk company such as an early-stage startup, or would you prefer the sanity and routine of a company that’s been around for a while? Would you appreciate the well-defined, relatively narrow expectations of a career at a large company, or would you prefer the freedom, flexibility, and variety of a small company? Is it most important to you to feel protected and cared for by a high-comfort company, or are you happiest when making sacrifices for the good of others at a high-service company such as a nonprofit?

In the end, it’s all about what you want and what makes you happy and satisfied. If you know what your sweet spot would look like and you put all your energy into finding or creating it, then all the other decisions along the way become trivial and you’re on your way to the mythical 40-year, same-company career. I hope to see you there!

Interested in joining the pMD team? Check out pMD's careers page for more information! To find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image: Tony Cenicola/The New York Times

Here's The Latest in Health Care:

•  Recent data released by the Centers for Medicare and Medicaid Services revealed that providers who stuck with accountable care organization (ACO) models are starting to see success in savings. One shining example is the ACO for NYC Health + Hospitals. They have reduced costs to Medicare by more than $31 million, generated $14 million in shared savings payments, and are providing other organizations with lessons in fostering leadership in ACOs.  Read More

•  Skin on fruits and veggies don't always form an impermeable barrier when it comes to pesticides.  Depending on the pesticide, it can either sit on the outer peel or can be designed to absorb into the tissue of the fruit or vegetable to keep out bugs that penetrate the skin. Do your research when it comes to deciding which fruits and veggies are necessary to buy organic!  Read More

•  On Wednesday, the Congressional Budget Office released an analysis of the current individual health insurance mandate. According to the report, getting rid of this requirement, which states that everyone in the country should have health insurance coverage, would save the government $338 billion over the next decade. However, the savings would come at the expense of more than 13 million individuals who will no longer have insurance coverage by 2027.  Read More

•  The National Institutes of Health's (NIH) All of Us Research Program will be using Fitbit devices for a longitudinal study aiming to collect data and gain insight on the characteristics of more than a million Americans.  The data being collected for this one-year study includes physical activity, heart rate, sleep, and other health outcomes.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

In March of 2016, I was thrilled to learn I’d be joining the pMD team. The interview process was challenging but rewarding, and I couldn’t wait to learn from all of the incredible people I had met throughout the process. After about a month into my new role, I received even more exciting news: my husband and I would be welcoming a new baby in December. While sharing this news with a new employer so soon after starting would typically be daunting for a parent-to-be, I felt nothing but excitement to be telling my colleagues. Since pMD values open communication,  I felt comfortable sharing the happy news and confident I would receive nothing but support. I am incredibly lucky to be part of a company that supports working parents.  However, not everyone is as fortunate in their work situations. Here are a few things to consider when researching whether a company provides flexibility and a supportive network around working parents.

Have you checked out Glassdoor?

There is so much you can find on the internet! Anonymous employee review sites, such as Glassdoor, can provide insight into a potential employer before you submit your application. When I was on the hunt for a new position, this was the first place I would go to either confirm my interest or remove a company from my list. When you’re on these sites, look for buzzwords that may indicate if an organization is family-friendly. Even if you’re not thinking of expanding your family anytime soon, these sites are a great place to get candid employee feedback about a company and its pros, cons, and thoughts on executive leadership.

Do those in leadership have children?

Nobody is going to be more understanding of a family, work-life balance than those who have been in your shoes. It’s typically helpful if those in leadership roles can empathize with your situation and understand if you need to take time off when your baby gets sick because they’ve experienced this first-hand themselves. How do you assess if those in leadership roles have children? This can be a bit trickier than simply reading online reviews. It’s okay if you need to do a little sleuthing before you get onsite! During an onsite interview, it can be helpful to take note of what you see around the office. Are there children’s drawings? Do you see family photos? When you ask what they did this past weekend, did any of it involve family-related activities? An onsite visit allows for an open line of communication with the company employees, so if you feel comfortable asking questions, definitely take advantage of your time there!

What benefits are offered?

Health benefits are important to research before starting with any company.  Having great health, vision, and dental benefits is extremely important when you’re thinking about taking care of your family. As a first-time mom, having good coverage affords me the option to take my child to the doctor on a regular basis, if needed. When you’re now thinking about more than just your own health, it’s critical that your employer provides strong and affordable health care options.

Are working conditions flexible?

Can you work from home if needed or are you required to be in the office from 8-5 every day? Having flexibility is so important for working parents. For example, if you’re a nursing mother, is your employer respectful of the time you need to pump? An employer that has no flexibility on hours spent in the office is something to consider for those who have a family, or are thinking of starting one in the future. Additionally, is the employer willing to work with you to optimize your working conditions? After welcoming my son last December, it was important for me to forgo all business travel until my son was at least a year old. I’m fortunate to work for a company that allows for such flexibility and accommodation.


Starting a family is one of the most exciting, and at times challenging, milestones in life. When you find an employer that is an advocate for working mothers and fathers, it can make a world of difference when trying to balance work and home life. While you can never know for certain what your situation may be in the future, taking steps to thoroughly do your research can help in making an educated decision as to what works best for both your career and your family.

Interested in working at pMD? Check out pMD's careers page for more information! To find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image: GJLP, CNRI, via Science Source

Here's The Latest in Health Care:

•  Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), announced that the agency will roll out a new "Meaningful Measures" initiative. This initiative will streamline quality measures and move away from fee-for-service models, allowing providers themselves to assess core issues surrounding high-quality care and the improvement of patient outcomes.  Read More

•  A new study recently found that stent procedures, most often used to relieve chest pain in patients who have blocked arteries, are virtually useless to many of them. The findings raise questions about how often stents should be used, if at all, to treat chest pain.  Read More

•  The future of personalized patient care is not in the hands of an EHR but that of apps. It's no secret that many EHRs lack usability and data integration functionality, which could eventually lead to their demise. EHRs aren't designed for treating patients. The problem is that EHR vendors have to engineer their products in a way that meets the government's criteria for meaningful use but at the expense of usable, exciting software. Early-adopter hospitals are already working on building their own apps to transform the future of personalized care.  Read More

•  On Wednesday, former President Barack Obama took to twitter to urge people to shop for Affordable Care Act health insurance. He encourages people to log on to the federal insurance exchange and sign up for coverage for next year.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

Happy Halloween, health care aficionados! On this day of candy, costumes, and frights, be on the lookout for some of these bizarre halloween-related incidents that may require ICD-10 codes. But I wouldn't get too comfortable with these codes just yet. Rumor has it that the latest revision to the International Classification of Diseases, or ICD as we fondly know it, is underway and the final ICD-11 will be released sometime in 2018. By this time next year, you could be looking at a new list of these unusual ICDs.

W49.01 - Hair causing external constriction, initial encounter
While wigs are a great addition to any Tina Turner, Cher, clown, or heavy metal ensemble, remember to double check the sizing before placing on head.

R44.1 - Visual hallucinations
It's not real, it's not real, it's not real.

X99.2 - Assault by sword or dagger
Your eight-year-old sure looks adorable in that knight costume but that plastic prop could do some real damage.

Z62.891 - Sibling rivalry
They can't both be Elsa from Frozen. It just won't end well.

W54.0 - Bitten by dog
You may love the idea of putting fido into a hot dog costume but he may have other ideas.

W22.02 -Walked into lamp post, initial encounter
Removing face masks while walking around at night might save you from bumping into those pesky lamp posts that may or may not have come out of nowhere.

Y93.D2 - Injury due to activity, sewing
Last-minute unicorn onesie costume alterations may result in injury.

R46.1 - Bizarre personal appearance
It's Halloween. Who doesn't this apply to?

Y93.D - Injury due to activities involving arts and crafts
Watch that hot glue gun when bedazzling your costume.

K03.81 - Cracked tooth
Trade in those Smarties and Jaw Breakers for Milky Ways and taffy.

Y93.75 - Injury due to activity, martial arts
Give sugar to your tiny ninja at your own risk.

Y04.1 - Human bite, initial encounter
It's all fun and games until someone takes their Twilight costume too literally.

A28.1 - Cat-scratch disease
See a black cat? Don't let it cross your path. Don't engage.

R10.84 - Generalized abdominal pain
...regretting that twentieth Reese's peanut butter cup...

If you'd like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image: Healthcare IT News via YouTube

Here's The Latest in Health Care:

•  On Wednesday, an advisory panel to the Centers of Disease Control and Prevention (CDC) recommended the use of Shingrix, a new shingles vaccine manufactured by GlaxoSmithKline. For the last decade, only one shingles vaccine has been available on the market. The head of the CDC still has yet to formally endorse the recommendation.  Read More

•  Genome sequencing is a technology that's becoming more mainstream and genomics expert J. Craig Venter is using that technology to help patients find out about any potentially fatal illnesses before symptoms come to light. However, many physicians are opposed to the exam as it may turn up false positives.  Read More

•  On Thursday, the President declared a public health emergency to deal with the opioid crisis. Agency and department heads are directed to use all appropriate emergency authorities to reduce the more than 140 deaths a day caused by the opioid epidemic.  Read More

•  Smaller practices are beginning to expand their offerings to include telemedicine services, in part to maintain patients that might otherwise go to outside telemedicine providers. Embracing telemedicine programs is also a way to attract patients from a broader region.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

What do you think of when you hear the word "cybersecurity"? If you’re anything like me, then this word can lead to a feeling of anxiety as headlines from the recent Equifax breach or the WannaCry attack flash across your mind. While cybersecurity can be an intimidating endeavor, take comfort in knowing that there are some straight forward steps that can be taken in order to strengthen cybersecurity in any industry. Before tackling preventative measures, however, we need to discuss what cybersecurity encompasses and its connection to health care.

What is cybersecurity?

Cybersecurity is "the body of technologies, processes, and practices designed to protect networks, computers, and data from attack, damage, and unauthorized access". This may seem like a lengthy definition, but it does cover all the aspects of cybersecurity and, more importantly, it highlights that cybersecurity is NOT just technology. Often, cybersecurity processes are more important than the technology itself in fending off malicious attackers.

Why is cybersecurity important in health care?

According to KPMG’s Cyber Healthcare & Life Sciences survey, 47% of health care providers reported instances of HIPAA violations or cyber attacks this year, rising 10% from the 2015 report. This number is only compounded by the increasing prevalence of connected devices, or the “Internet of Things,” which has contributed to the growth of new exploits that take advantage of lower security thresholds on these seemingly limited devices.

HIPAA’s Security Rule addresses some of the concerns that stem from having extremely valuable personal health information open to potential attacks by providing “a framework for managing risk.” The rule basically covers administrative safeguards, which includes performing risk analysis, designating security credentials, and training employees. This rule also details physical safeguards, which includes everything from locks on doors, to password protected workstations, to actual security guards. And finally, technical safeguards are also discussed, which is the part that you would more likely think of when you hear the word “cybersecurity” and includes things like access control and transmission security. While this framework gives broad suggestions on how to avoid potential security breaches, it doesn’t dive deep into specific suggestions, which begs the question:

What can we do to ensure our patients' health information is safe?

1. Stay up to date on industry trends and cybersecurity threats

One great resource to remain up to date is the HIMSS Cross-Sector Cyber Security reports. These reports are released frequently and include updates on attacks and vulnerabilities across health care and other industries.

2. Update systems regularly

A core lesson from the WannaCry attacks: updating software systems regularly and utilizing cloud-based systems (like pMD!) when possible to avoid running outdated versions of software can help ensure that known vulnerabilities are not left exposed.

3. Be wary of potentially harmful links

Spam email remains one of the top ways malware spreads throughout networks. Being vigilant of the links you click on and where you enter sensitive data is an easy way to avoid falling victim to phishing attacks.

4. Plan your response

If you do experience an attack, a response plan can help prevent exacerbating the situation through mismanagement. Coordinated response efforts are key to minimizing the impact of any attack and the plan should include addressing the root of the problem, not just the effects.

From employee training, to processes for handling sensitive patient data and reacting in the event of a violation, to technical specifications, one thing is clear: cybersecurity is a team effort.

If you have any questions about today’s blog post or would like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

More Resources:



Image: Alden Chadwick/Getty Images

Here's The Latest in Health Care:

•  The Veterans Coordinated Access and Rewarding Experiences Act, or CARE act, would make it easier to share patient records between the VA and outside providers. The proposal hopes to continue to improve the veteran experience by building a high-performance network and address health IT problems.  Read More

•  On Wednesday, the F.D.A. approved the second gene-altering treatment that reboots a patient's own immune cells to kill cancer. The approval, however, is not without controversy. The side effects can be life-threatening and in some cases fatal. The treatment is currently available only at centers where doctors and nurses have been trained in providing this specific treatment.  Read More

•  At this year's Medical Group Management Association (MGMA) conference, two experts presented their advice on benchmarking. Benchmarking can help physician practices compare themselves to their competitors, evaluate their performance, and identify areas of strengths and weaknesses.  Read More

•  People with diabetes struggle with a lifelong challenge to maintain their blood sugar levels. However, new emerging diabetes technology may ease that blood testing process, some even avoiding the dreaded finger prick.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.