Patient Engagement Changes Bigly for MIPS In 2019

Last week, CMS released the QPP final rule for 2019. We will be doing a series of blogs and webinars to discuss the changes in detail and how they impact EHR developers and providers. However, there is one change that deserves a blog of it’s own. In my opinion, it is the biggest change since the start of the Meaningful Use program almost a decade ago.

 Anyone who has ever been involved in any Meaningful Use/MIPS attestation has probably heard or said this – “How can a provider control what the patient does?” This is in reference to the patient engagement measures that required the patient to take some action. CMS finally listened and has addressed this in the 2019 final rule. Here is relevant text buried in the 2000+ page document:

 “After additional review, we noted that successful performance predicated solely on a patient’s action has inadvertently created burdens to MIPS eligible clinicians and detracts from progress on Promoting Interoperability measure goals of focusing on patient care, interoperability and leveraging advanced used of health IT.”

 Duh! What took that long?


It is not just a single measure that is being adjusted. CMS has removed the following four measures from the Promoting Interoperability category of MIPS for 2019 and beyond.

  1. View, Download, and Transmit

  2. Patient Generated Health Data

  3. Patient-Specific Education

  4. Secure Messaging

So, does that mean that you don’t need patient portals? Quite the contrary. Although the above measures have been removed, the “Provide Patient Access” measure has been renamed to Provide Patient Electronic Access”. This measure alone will be 40% of the PI category score. CMS has removed the concept of Base Score and this is a required measure to achieve any score in the Promoting Interoperability category. There is no exception available for this measure.

Following up on the comments above, CMS has further clarified that this measure does NOT require that patients actually use the portal or the API.

“The Provide Patients Electronic Access to Their Health Information measure does not require that patients actually access their information. Patients should be able to access their health information on demand, and we encourage MIPS eligible clinicians to maintain the appropriate functionalities for patient access to their health information at all times unless the system is undergoing scheduled maintenance, which should be limited.”

The addition of word “Electronic” is significant. The calculation of this measure is defined in the EHR certification criteria and requires that two conditions be met:

  1. Patient data must be available to view, download, or transmit AND

  2. Patient data must be available to an API

There is a strong emphasis throughout the rule to provide “electronic access” of health information. The EHR Reporting Program RFI released as part of the 21st Century Cures Act (Cures Act) mentions “Conformance to certification testing” as one of the mandated categories. CMS is taking interoperability and data blocking very seriously. As I discussed in a previous post on FHIR, it’s time to embrace this change and get ready for it.

Contact us if you are interested in learning how you can get ready for 2019. Stay tuned for our upcoming webinar where we will be taking a deep dive into all the changes brought about by the QPP 2019 final rule.