MVP: Adopting Best Practices and Promoting Patient Safety within Emergency Medicine 2026
Most applicable medical specialty(s): Emergency Medicine, Nonphysician Practitioners, Nurse Practitioner, Physician Assistants
The Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP focuses on important assessors of the care emergency clinicians provide to patients with undifferentiated high-risk conditions. By focusing on these specific measures and activities, emergency clinicians can reduce clinical variability, improve the quality of emergency care and potentially lower costs.
Measures/Activities and Requirements (MVP ID: G0057):
Quality
To fulfill quality requirements:
- You must report 4 quality measures from the list below
- At least 1 measure must be an outcome measure.
- If no outcome measures are available, you may report a high priority measure.
- You must collect data for each measure for the 12-month performance period of the associated performance year (e.g., January 1, 2026 – December 31, 2026).
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.
Quality measures
| ID | Title | Specs |
|---|---|---|
| 065 | Appropriate Treatment for Upper Respiratory Infection (URI) | Details |
| 116 | Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis | Details |
| 321 | CAHPS for MIPs Clinician/Group Survey | Details |
| 331 | Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse) | Details |
| 415 | Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older | Details |
| 416 | Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years | Details |
| ACEP50* | ED Median Time from ED arrival to ED departure for all Adult Patients | Not supported by MIPSpro* |
| ACEP52* | Appropriate Emergency Department Utilization of Lumbar Spine Imaging for Atraumatic Low Back Pain | Not supported by MIPSpro* |
| ECPR46 | Avoidance of Opiates for Low Back Pain or Migraines | Details |
Improvement Activities
To fulfill improvement activity requirements:
- You must report 1 improvement activity from the list below.
Improvement activities no longer have assigned weights.
Improvement activities
| ID | Title |
|---|---|
| IA_BE_4 Engagement of Patients through Implementation of New Patient Portal | To receive credit for this activity, MIPS eligible clinicians must implement and provide access to a… |
| IA_BE_6 Regularly Assess Patient Experience of Care and Follow Up on Findings | Collect and follow up on patient experience and satisfaction data. This activity also requires follo… |
| IA_BMH_12 Promoting Clinician Well-Being | Develop and implement programs to support clinician well-being and resilience—for example, through r… |
| IA_MVP Practice-Wide Quality Improvement in MIPS Value Pathways | Create a quality improvement initiative within your practice and create a culture in which all staff… |
| IA_PCMH Electronic submission of Patient Centered Medical Home accreditation | I attest that I am a Patient Centered Medical Home (PCMH) or Comparable Specialty Practice that has … |
| IA_PSPA_1 Participation in an AHRQ-listed patient safety organization. | Participation in an AHRQ-listed patient safety organization…. |
| IA_PSPA_15 Implementation of an ASP | Leadership of an Antimicrobial Stewardship Program (ASP) that includes implementation of an ASP that… |
| IA_PSPA_7 Use of QCDR data for ongoing practice assessment and improvements | Participation in a Qualified Clinical Data Registry (QCDR) and use of QCDR data for ongoing practice… |
Cost
Important information to consider:
You’ll only be scored on the cost measures in this MVP for which you meet or exceed the established case minimum.
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.
| ID | Title | Specs |
|---|---|---|
| COST_EDV_1 | Emergency Medicine | Details |
Foundational Layer – Promoting Interoperability
To fulfill Promoting Interoperability requirements:
- 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.
- 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.
Promoting Interoperability measures (all MVPs)
| ID | Title |
|---|---|
| PI_EP_1 | e-Prescribing |
| PI_EP_2 | Query of the Prescription Drug Monitoring Program (PDMP) |
| PI_EP_2_EX_1 | Query of the Prescription Drug Monitoring Program (PDMP) Exclusion |
| PI_EP_2_EX_2 | Query of the Prescription Drug Monitoring Program (PDMP) Exclusion |
| PI_HIE_1 | Support Electronic Referral Loops By Sending Health Information |
| PI_HIE_4 | Support Electronic Referral Loops By Receiving and Reconciling Health Information |
| PI_HIE_5 | Health Information Exchange (HIE) Bi-Directional Exchange |
| PI_HIE_6 | Enabling Exchange Under the Trusted Exchange Framework and Common AgreementTM (TEFCATM) |
| PI_INFBLO_1 | Actions to Limit or Restrict the Compatibility of CEHRT |
| PI_LVITC_2 | Support Electronic Referral Loops By Receiving and Reconciling Health Information Exclusion |
| PI_LVOTC_1 | Support Electronic Referral Loops By Sending Health Information Exclusion |
| PI_LVPP_1 | e-Prescribing Exclusion |
| PI_ONCACB_1 | ONC-ACB Surveillance Attestation |
| PI_ONCDIR_1 | ONC Direct Review Attestation |
| PI_PEA_1 | Provide Patients Electronic Access to Their Health Information |
| PI_PHCDRR_1 | Immunization Registry Reporting |
| PI_PHCDRR_1_EX_1 | Immunization Registry Reporting Exclusion |
| PI_PHCDRR_1_EX_2 | Immunization Registry Reporting Exclusion |
| PI_PHCDRR_1_EX_3 | Immunization Registry Reporting Exclusion |
| PI_PHCDRR_1_PRE | Immunization Registry Reporting Active Engagement Level 1 |
| PI_PHCDRR_1_PROD | Immunization Registry Reporting Active Engagement Level 2 |
| PI_PHCDRR_2 | Syndromic Surveillance Reporting |
| PI_PHCDRR_2_PRE | Syndromic Surveillance Reporting Active Engagement Level 1 |
| PI_PHCDRR_2_PROD | Syndromic Surveillance Reporting Active Engagement Level 2 |
| PI_PHCDRR_3 | Electronic Case Reporting |
| PI_PHCDRR_3_EX_1 | Electronic Case Reporting Exclusion |
| PI_PHCDRR_3_EX_2 | Electronic Case Reporting Exclusion |
| PI_PHCDRR_3_EX_3 | Electronic Case Reporting Exclusion |
| PI_PHCDRR_3_PRE | Electronic Case Reporting Active Engagement Level 1 |
| PI_PHCDRR_3_PROD | Electronic Case Reporting Active Engagement Level 2 |
| PI_PHCDRR_4 | Public Health Registry Reporting |
| PI_PHCDRR_4_PRE | Public Health Registry Reporting Active Engagement Level 1 |
| PI_PHCDRR_4_PROD | Public Health Registry Reporting Active Engagement Level 2 |
| PI_PHCDRR_5 | Clinical Data Registry Reporting |
| PI_PHCDRR_5_PRE | Clinical Data Registry Reporting Active Engagement Level 1 |
| PI_PHCDRR_5_PROD | Clinical Data Registry Reporting Active Engagement Level 2 |
| PI_PHCDRR_6 | Public Health Reporting Using Trusted Exchange Framework and Common AgreementTM (TEFCATM) |
| PI_PPHI_1 | Security Risk Analysis |
| PI_PPHI_2 | High Priority Practices Safety Assurance Factors for EHR Resilience (SAFER) Guide |
Foundational Layer – Population Health
- You won’t be required to select a population health measure during registration. 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.
Improvement activities (all MVPs)