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MVP: Value in Primary Care

Most applicable medical specialty: 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

To fulfill quality requirements:

  1. You must select 4 quality measures from the list below
  2. At least 1 measure must be an outcome measure
    • If no outcome measures are available, you may report a high priority measure.
  3. You must collect data for each measure for the 12-month performance period of the associated performance year (e.g., January 1, 2025 – December 31, 2025).

TIP: Make sure that you select measures that are appropriate to your patient population. Measures that don’t meet case minimum or data completeness criteria will earn zero points.

IDTitleSpecs
001Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)Details
047Advance Care PlanDetails
134Preventive Care and Screening: Screening for Depression and Follow-Up PlanDetails
236Controlling High Blood Pressure Details
305Initiation and Engagement of Substance Use Disorder TreatmentDetails
321CAHPS for MIPS Clinician/Group SurveyDetails
438Statin Therapy for the Prevention and Treatment of Cardiovascular DiseaseDetails
475HIV ScreeningDetails
483Person-Centered Primary Care Measure Patient Reported Outcome Performance Measure (PCPCM PRO-PM)Details
487Adult Immunization StatusDetails
493Adult Immunization StatusDetails
497Preventive Care and Wellness (composite)Details
504Initiation, Review, And/Or Update To Suicide Safety Plan For Individuals With Suicidal Thoughts, Behavior, Or Suicide RiskDetails

Improvement Activities

To fulfill improvement activity requirements:

1. You must report 1 improvement activity from the list below.

Beginning in 2025, improvement activities don’t have assigned weights.

Download 2025 Improvement Activities Inventory (ZIP)

IDTitle
IA_AHE_12Practice Improvements that Engage Community Resources to Address Drivers of Health
IA_AHE_3Promote Use of Patient-Reported Outcome Tools
IA_AHE_9Implement Food Insecurity and Nutrition Risk Identification and Treatment Protocols
IA_BE_6Regularly Assess Patient Experience of Care and Follow Up on Findings
IA_BE_4Engagement of patients through implementation of improvements in patient portal
IA_BE_12Use evidence-based decision aids to support shared decision-making.
IA_CC_13Practice Improvements to Align with OpenNotes Principles
IA_CC_2Implementation of improvements that contribute to more timely communication of test results
IA_PM_26Vaccine Achievement for Practice Staff: COVID-19, Influenza, and Hepatitis B
IA_MVPPractice-Wide Quality Improvement in MIPS Value Pathways
IA_PCMHElectronic submission of Patient Centered Medical Home accreditation
IA_PM_11Regular review practices in place on targeted patient population needs
IA_PM_13Chronic Care and Preventative Care Management for Empaneled Patients
IA_PM_16Implementation of medication management practice improvements
IA_PM_22Improving Practice Capacity for Human Immunodeficiency Virus (HIV) Prevention Services
IA_PM_23Use of Computable Guidelines and Clinical Decision Support to Improve Adherence for Cervical Cancer Screening and Management Guidelines
IA_PM_25Save a Million Hearts: Standardization of Approach to Screening and Treatment for Cardiovascular Disease Risk

Cost

Important information to consider:

  1. You don’t have to submit any data for this performance category. We’ll use Medicare claims data to calculate your cost measure performance.
    • You don’t select cost measures during MVP registration. CMS will calculate your performance on all the cost measures included in the MVP based on available Medicare claims data.
  2. You’ll only be scored on the cost measures in this MVP for which you meet or exceed the established case minimum.
IDTitleSpecs
COST_ACOPD_1Asthma/Chronic Obstructive Pulmonary Disease (COPD)Details
COST_D_1DiabetesDetails
COST_DEP_1DepressionDetails
COST_HF_1Heart FailureDetails
TPCC_1Total Per Capita Cost (TPCC)Details

Foundational Layer – Promoting Interoperability

To fulfill Promoting Interoperability requirements:

  1. Submit the required Promoting Interoperability measures (the same as under traditional MIPS) listed below. Bonus points are available for reporting measures that aren’t required.
    • If you’re reporting as a subgroup, you’ll submit your affiliated group’s data for the Promoting Interoperability performance category.
  2. Review if you qualify for automatic reweighting of the Promoting Interoperability performance category based on your clinician type, special status, or an approved Promoting Interoperability Performance Category Hardship Exception Application.

Special Status for Automatic Reweighting:

  • Ambulatory Surgical Center (ASC)-based
  • Hospital-based
  • Non-patient facing
  • Small practice

Promoting Interoperability Performance Category Hardship Exception Qualifications:

  • Decertified EHR technology
  • Insufficient internet connectivity
  • Experience extreme and uncontrollable circumstances (e.g., disaster, practice closure, severe financial distress, vendor issues)
  • Lack control over availability of CEHRT (Certified Electronic Health Record Technology)

Note: Promoting Interoperability requirements are the same in MVPs as they are in traditional MIPS. Learn more about Promoting Interoperability requirements.

IDTitle
PI_EP_1e-Prescribing
PI_EP_2Query of the Prescription Drug
Monitoring Program (PDMP)
PI_EP_2_EX_1Query of the Prescription Drug Monitoring Program (PDMP)
PI_EP_2_EX_2Query of the Prescription Drug Monitoring Program (PDMP) Exclusion
PI_HIE_1Support Electronic Referral Loops By Sending Health Information
PI_HIE_4Support Electronic Referral Loops By Receiving and Reconciling Health Information
PI_HIE_5Health Information Exchange (HIE)
Bi-Directional Exchange
PI_HIE_6Enabling Exchange Under TEFCA
PI_INFBLO_1Actions to Limit or Restrict the Compatibility of CEHRT
 PI_LVITC_2Support Electronic Referral Loops By Receiving and Reconciling Health Information Exclusion
 PI_LVOTC_1Support Electronic Referral Loops By Sending Health Information Exclusion
PI_LVPP_1e-Prescribing Exclusion
PI_ONCACB_1ONC-ACB Surveillance Attestation
PI_ONCDIR_1ONC Direct Review Attestation
PI_PEA_1Provide Patients Electronic Access to
Their Health Information
PI_PHCDRR_1Immunization Registry Reporting
PI_PHCDRR_1_EX_1Immunization Registry Reporting Exclusion
PI_PHCDRR_1_EX_2Immunization Registry Reporting Exclusion
PI_PHCDRR_1_EX_3Immunization Registry Reporting Exclusion
PI_PHCDRR_1_PREImmunization Registry Reporting Active Engagement Level 1
PI_PHCDRR_1_PRODImmunization Registry Reporting Active Engagement Level 2
PI_PHCDRR_2Syndromic Surveillance Reporting
PI_PHCDRR_2_PRESyndromic Surveillance Reporting Active Engagement Level 1
PI_PHCDRR_2_PRODSyndromic Surveillance Reporting Active Engagement Level 2
PI_PHCDRR_3Electronic Case Reporting
PI_PHCDRR_3_EX_1Electronic Case Reporting Exclusion
PI_PHCDRR_3_EX_2Electronic Case Reporting Exclusion
PI_PHCDRR_3_EX_3Electronic Case Reporting Exclusion
PI_PHCDRR_3_PREElectronic Case Reporting Active Engagement Level 1
PI_PHCDRR_3_PRODElectronic Case Reporting Active Engagement Level 2
PI_PHCDRR_4Public Health Registry Reporting
PI_PHCDRR_4_PREPublic Health Registry Reporting Active Engagement Level 1
PI_PHCDRR_4_PRODPublic Health Registry Reporting Active Engagement Level 2
PI_PHCDRR_5Clinical Data Registry Reporting
PI_PHCDRR_5_PREClinical Data Registry Reporting Active Engagement Level 1
PI_PHCDRR_5_PRODClinical Data Registry Reporting Active Engagement Level 2
PI_PPHI_1Security Risk Analysis
PI_PPHI_2SAFER Guides High Priority Practices Guide

Foundational Layer – Population Health

  • You won’t be required to select a population health measure during registration. This is different from the 2024 MVP registration process requiring you to select a population health measure. You don’t have to submit any data for this measure, we will calculate all available population health measures for you, using administrative claims data.
  • This measure will be excluded if you can’t be scored on either (the measure doesn’t have a benchmark or you don’t meet the case minimum).
  • Population health isn’t a new performance category. The population health measures within the MVP will be scored as part of the quality performance category provided you meet the case minimum.
  • Subgroups will be evaluated at the affiliated group level.
IDTitleSpecs
479 
Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-Based Incentive Payment System (MIPS) Groups
Details
484 Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic ConditionsDetails

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