Finalized Changes to 2026 MIPS Value Pathway for Emergency Medicine

April 17, 2026

The Centers for Medicare and Medicaid Services (CMS) finalized updates to the Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP for the 2026 performance year.

Although MVP reporting is currently voluntary, CMS has expressed the intention of sunsetting traditional MIPS and transitioning to MVPs entirely in the future. In the 2025 MIPS proposed rule, CMS requested feedback on the possibility of making MVPs mandatory as early as 2029.

Anatomy IT will continue to advocate for MVPs to be optional and for improvements to this MVP to make it possible for all emergency medicine specialists to be successful.

In this blog, we’ll break down what MVPs are, how to report them, and what changes were finalized in the 2026 Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP.

What is a MIPS Value Pathway (MVP)?

CMS introduced MVPs as an alternative reporting option to traditional MIPS in 2023. According to CMS, MVPs aim to simplify MIPS, reduce reporting burden, and help patients make more informed decisions when choosing their clinicians.

Each MVP has its own specific set of quality measures, improvement activities (IAs), and cost measures, and you are limited to those measures and activities when reporting the MVP. The Promoting Interoperability (PI) category is included as part of a “foundational layer,” meaning that PI requirements are the same for every MVP. Also included in the foundational layer is a population health measure, which contributes to your overall Quality score.

Can I Report an MVP Through a Registry?

Since 2023, Qualified Registries (QRs) and Qualified Clinical Data Registries (QCDRs), such as the Emergency Clinical Performance Registry (E-CPR), have been required to support all measures in the Quality, IA, and PI categories of the MVPs relevant to their clinicians. They are not required to support the Cost category, Population Health measures, QCDR measures, or the CAHPS for MIPS Survey.

How Are MVPs Different from Traditional MIPS?

The table below highlights the differences by category between reporting traditional MIPS versus reporting an MVP.

If you choose to report both traditional MIPS and an MVP, CMS will assign you the higher of the two scores.

How Do I Report an MVP?

To report an MVP for the 2026 performance year, you must register between April 1, 2026, and November 30, 2026, at 8 pm ET. Registration is available through your QPP account.

At the time of registration, you must include the following information:

The MVP you are choosing to report,
Any administrative claims measures you would like to be included as 1 of your 4 required Quality measures,
Whether you are planning to count the CAHPS for MIPS Survey measure towards 1 of the 4 required Quality measures, and
Your participation level (group, subgroup, individual, APM).
- If you are reporting at the group level, you will have the chance to attest to being a single-specialty group or a small multi-specialty group (15 or fewer clinicians).
- If you report at the group level and are part of a large multi-specialty group (more than 15 clinicians), you are required to report at the subgroup level in 2026.

If you are an Anatomy IT client, we will discuss whether to report an MVP during your kickoff call.

What Are the 2026 Changes to the MVP for Emergency Medicine?

CMS finalized the following changes to the 2026 Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP:

Removed 1 quality measure:

- 487: Screening for Social Drivers of Health *

Removed 3 improvement activities:

- AHE_12: Practice Improvements That Engage Community Resources to Address Drivers of Health *
- CC_2: Implementation of Improvements That Contribute to More Timely Communication of Test Results *
- PM_26: Vaccine Achievement for Practice Staff: COVID-19, Influenza, and Hepatitis B *

*These measures were also removed from traditional MIPS.

To see all the measures and activities included in Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP, click on the category names below.

Emergency Medicine Measures (Specific to This MVP)

Quality

Emergency Medicine MVP Quality Measures

Report 4 of the following (at least 1 outcome or high priority measure):

65: Appropriate Treatment for Upper Respiratory Infection (URI) (high priority)
116: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (high priority)
321: CAHPS for MIPs Clinician/Group Survey (high priority)
331: Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse) (high priority)
415: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older (high priority)
416: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years (high priority)
ACEP50: ED Median Time from ED arrival to ED departure for all Adult Patients (outcome)
ACEP52: Appropriate Emergency Department Utilization of Lumbar Spine Imaging for Acute Atraumatic Low Back Pain (high priority)
ECPR46: Avoidance of Opiates for Low Back Pain or Migraines (high priority)
HCPR24: Appropriate Utilization of Vancomycin for Cellulitis (high priority)

Improvement Activities

Emergency Medicine MVP Improvement Activities

Report 1 of the following:

BE_4: Engagement of Patients Through Implementation of Improvements in Patient Portal
BE_6: Regularly Assess Patient Experience of Care and Follow Up on Findings
BMH_12: Promoting Clinician Well-Being
PSPA_1: Participation in an AHRQ-Listed Patient Safety Organization
PSPA_7: Use of QCDR Data for Ongoing Practice Assessment and Improvements
PSPA_15: Implementation of an Antimicrobial Stewardship Program (ASP)
PCMH: Electronic submission of Patient Centered Medical Home accreditation
MVP: Practice-Wide Quality Improvement in MIPS Value Pathways

Cost

Foundational Layer (Applies to All MVPs)

Population Health

Population Health Measures

You will be automatically scored on both of the following population health measures, if applicable. CMS will assign you the higher of the two scores.

479: Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-Based Incentive Payment Systems (MIPS) Groups
484: Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions

Promoting Interoperability

Promoting Interoperability Requirements

The PI requirements for an MVP are the same as those for traditional MIPS.

All of the following attestations and measures are required (no exclusions):

Use of CEHRT
Actions to Limit or Restrict Interoperability of CEHRT
ASTP/ONC Direct Review
High Priority SAFER Guides Assessment
Security Risk Analysis
Provide Patients Electronic Access to Their Health Information

All of the following measures are required (unless claiming an exclusion):

e-Prescribing
Query of Prescription Drug Monitoring Program (PDMP)
Immunization Registry Reporting
Electronic Case Reporting

One of the following options is required:

Option 1: Support Electronic Referral Loops by Sending Health Information + Support Electronic Referral Loops by Receiving and Reconciling Health Information
- Exclusions are available for both measures in this option.
Option 2: Health Information Exchange (HIE) Bi-Directional Exchange
Option 3: Enabling Exchange Under the Trusted Exchange Framework and Common Agreement (TEFCA

You can optionally report on one of the following measures for up to 5 bonus points in the PI category:

Syndromic Surveillance Reporting
Clinical Data Registry Reporting
Public Health Registry Reporting
Public Health Reporting Using TEFCA

Is Reporting the Emergency Medicine MVP in 2026 Worth It?

Yes. CMS is considering making MVP reporting mandatory starting in 2029. That means there are only a few MIPS performance years left to find flaws, gather data, and recommend improvements before MVPs become the only way in which you can participate in MIPS and avoid a penalty. By reporting the 2026 Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP, you will:

Gain invaluable experience to prepare you for mandatory MVP reporting,
Not negatively impact your MIPS payment adjustment as long as you also report traditional MIPS (even if you score poorly in the MVP), and
Be able to provide real-world feedback to CMS to help them improve the MVP available to you before MVP reporting becomes mandatory. You can communicate with us to describe your experience with the MVP or you can tell CMS directly by commenting on the 2027 Medicare Physician Fee Schedule Proposed Rule this summer or by following the steps outlined here by CMS.

Next Steps

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Written By: Sarrah Hakim, MHSA