Quality & Practice

Advancing Care Information

Within the Quality Payment Program, there are 2 paths providers can choose and use to report quality data:


The Advancing Care Information (ACI) category of MIPS, replaces the Medicare EHR Incentive Program, also known as Meaningful Use and is responsible for 25% of your total MIPS score.

If you furnish 75% or more of your professional services in sites identified by Place of Service (POS) codes 21 (inpatient hospital), 22 (outpatient hospital) or 23 (emergency room) you are exempt from ACI. This means your Quality score is worth 85% of your total score.

MIPS Advancing Care Information Score

There are 2 measure set options for reporting. The option you use to submit your data is based on your electronic health record (EHR) edition.

  • Option 1: Advancing Care Information Objectives and Measures
  • Option 2: 2017 Advancing Care Information Transition Objectives and Measures

To help our members with their ACI reporting, AAPM&R has created an Advancing Care Information Guide to help them explore the measure set that works with their EHR.

All of your MIPS reporting can be completed using the Spine Quality Outcomes Database.



Hardship Exception

The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program website.

MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:

  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of Certified EHR Technology (CEHRT)

There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application.

For more information about the Quality Payment Program hardship application process, visit the Quality Payment Program website.

Advice for Physiatrists: 

You will likely have a good shot of being approved for the Hardship Exception if you select (and meet the criteria for) “Lack of Control Over CEHRT.” In order to attest to this hardship, you would have to attest to having a lack of control in 1 or more practice locations where more than 50% of your outpatient patient encounters occurred. If you meet this definition, the attestation is relatively simple— you simply check a box and are not required to provide any documentation at the time of submission (although CMS can always come back and audit you so retention of documentation internally is recommended). Please note, this is simply a suggestion and is not at all guaranteed to work.