MSSP quality measures for 2027: the APP Plus set

This page summarizes CMS's fact sheet on the CY 2027 Physician Fee Schedule final rule (CMS-1848-F) for the Shared Savings Program. It is not legal or reporting advice. Confirm anything your submission depends on against the rule text in the Federal Register and CMS's Quality Payment Program resources.

The eight measures for PY 2027

Source: CMS, CY 2027 PFS final rule fact sheet: Medicare Shared Savings Program, Table 1.

The ACO reports the five clinical measures: 001, 112, 113, 134 and 236. The two claims measures come from Medicare claims, and CAHPS is a patient survey.

What changed for 2027

• Two measures are gone. CMS removed Initiation and Engagement of Substance Use Disorder Treatment (Quality ID 305) and Adult Immunization Status (Quality ID 493).
• MIPS CQMs stay. CMS extended the MIPS CQM collection type for PY 2027 and later, so ACOs reporting that way don't have to switch. The reporting incentive for MIPS CQMs is extended with it.
• Medicare eCQMs are a new collection type. A Medicare eCQM is an APP Plus eCQM reported on the ACO's assigned beneficiaries only, not its all-payer, all-patient population. CMS publishes no separate specifications. ACOs use the eCQM specifications and a different identifier CMS provides.
• Medicare CQMs are scored on flat benchmarks. For PY 2027 and later, every Medicare CQM measure is scored on a flat benchmark. Measures 001, 134 and 236 reported as Medicare CQMs get flat benchmarks starting PY 2026.
• Medicare eCQMs get flat benchmarks too, starting with the CY 2027 performance period (2029 MIPS payment year). Medicare eCQMs don't qualify for the eCQM/MIPS reporting incentive or the Complex Organization Adjustment.
• The scoring policy for excluded measures applies less often. For PY 2027 and later, it applies only when the ACO's MIPS quality score is calculated on fewer than five measures.

ACOs can report all five clinical measures as Medicare eCQMs, or mix eCQMs, MIPS CQMs, Medicare CQMs and Medicare eCQMs, and still meet the reporting requirement and the quality performance standard.

Which collection type to choose

The practical question is data. An ACO whose practices run on several EHRs often can't pull clean all-payer data from every one. Medicare eCQMs exist for exactly that case: CMS says they support ACOs "that want to report eCQMs but are unable to operationally report on all patient/all payer data due to data aggregation challenges."

Two reporting rules that trip ACOs

75% data completeness. For every measure it submits, the ACO must report on at least 75% of the beneficiaries who meet the measure's denominator criteria.

95% coverage when excluding TINs. From PY 2026, an ACO can leave a participant TIN out of a measure's submission when the practice closed unexpectedly, when the TIN's EHR is built for a specialty and doesn't support the measure, or in other cases CMS allows. The remaining TINs must cover at least 95% of the ACO's assigned beneficiaries.

CEHRT in 2027: three ways to comply

For PY 2027 and later, CMS replaced the old certified-EHR use requirements. An ACO picks one:

1. Report one measure electronically. Completely report at least one of the five ACO-reported measures as an eCQM or Medicare eCQM, using CEHRT certified to ONC criteria.
2. Report one measure with FHIR data. Completely report at least one of the five using CEHRT, and attest to using data from an HL7 FHIR-based API through a Health IT Module certified for standardized API access.
3. Attest to one CEHRT use metric:
   • E-prescribing. At least one permissible prescription written by an ACO provider in each participating TIN was sent electronically using CEHRT. TINs with fewer than 100 permissible prescriptions are excluded.
   • Health information exchange. At least one ACO provider in each TIN exchanged data bi-directionally for at least one patient through an HIE, using CEHRT.
   • Provider-to-patient exchange. At least one ACO provider in each TIN gave at least one patient electronic access to their health information using CEHRT.

ACOs choosing route 3 can exclude TINs made up entirely of providers with special status or hardship conditions without asking CMS, and must keep the documentation for audit. Every ACO must publicly report which of the three routes it chose.

The direction: digital quality measures

CMS frames these changes as steps toward digital quality measures (dQMs): measures calculated from structured electronic data, increasingly through FHIR APIs, rather than abstracted by hand. Keeping MIPS CQMs available, CMS says, lets ACOs "focus their resources and efforts on the transition to dQM reporting." Medicare eCQMs and CEHRT route 2 point the same way.

For an ACO, that means the quality score increasingly depends on what's structured in the chart: the A1c result with its date, the blood pressure reading, the screening order and its result, the PHQ-9 and its follow-up plan.

Other Shared Savings Program changes in the same rule

The quality changes ship alongside financial ones. Per the same fact sheet:

• The BASIC track Level E sharing rate rises from 50% to 60%.
• The prior savings adjustment's scaling factor rises from 50% to 75%.
• ACOs can apply to reduce or eliminate Part B cost sharing for beneficiaries from 1 April 2027 (excluding DMEPOS and prescription drugs).
• ACOs applying for a 1 January 2027 start can change their track selection during Phase 2 RFI, 12–17 November 2026.
• Practitioners in Shared Savings Program ACOs can bill a new E/M modifier, B2, that adds 32% to the visit. See G2211, B1 and B2 modifiers.

How an ACO runs this in practice

The measures are scored once a year. The work behind them happens every week, across every practice:

1. Find the gaps across the panel. Which assigned patients are due for a colorectal screen, have no A1c this year, or had a last blood pressure at or above 140/90.
2. Reach the patient. Calls and texts to book the visit, the lab draw or the screening.
3. Close the gap at the visit. The overdue item is in front of the clinician before the patient walks in.
4. Get it into the chart as structured data. A result buried in a scanned PDF doesn't count toward an eCQM.
5. Compute the measure and submit. Per TIN, per collection type, with the 75% completeness check done before the deadline, not after.

Where Caesar Health fits

Caesar Health runs steps 1 through 5 alongside the EHRs an ACO's practices already use.

• Care-gap worklist across the panel. Caesar refreshes every patient's open gaps nightly and gives care managers one list to work, across practices on different EHRs.
• eCQMs computed from the chart. Caesar computes the five ACO-reported APP Plus measures, including Diabetes: Glycemic Status Assessment Greater Than 9% and Controlling High Blood Pressure, from structured chart data.
• Gaps in front of the clinician. Open gaps show in the pre-visit brief and on the day sheet, and the AI Scribe flags them during the encounter.
• Outreach that books the visit. The Phone Agent and patient messaging call and text the patients on the list and book them.
• Care programs that move the numbers. CCM, RPM and APCM programs for the patients behind measures 001 and 236. See ACOs and provider networks.