The Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes MVP (G0054) enters the 2027 MIPS performance period with eight quality measures, a new core-measure requirement, and one fewer measure than 2026.
CMS removed Q326 (Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy) from the set and replaced the previous outcome-measure requirement with a mandatory core measure selection.
Participants report four quality measures — including one applicable core measure — and attest to one improvement activity. CMS calculates cost and population-health components from claims data.
The CY 2027 PFS final rule (CMS-1848-F), effective January 1, 2027, finalizes these changes for the 2029 MIPS payment year. Here is what the rest of this guide covers:
- The 8 quality measures and their collection types
- Small-practice exceptions and registration reminders
- Promoting Interoperability considerations for MVP participants
- Cost, population health, and improvement activity components
- How the core-measure requirement works (and why it replaced the outcome-measure rule)
TLDR — STROKE CARE MVP 2027 (G0054)
Eight measures. Four reported. One must be a core measure.
- 🚫 Q326 (Chronic Anticoagulation Therapy) removed from the 2027 MVP
- ⭐ Core measures for this MVP — Q047, Q236, Q441 — one must be included in the four reported
- 📋 Attest to one improvement activity from the MVP’s 10-option list
- 💰 Cost and population health calculated by CMS from claims — no separate submission
- 📅 PY 2027 performance → CY 2029 MIPS payment year
What are the 2027 stroke care MVP quality measures?
The finalized measure set contains eight quality measures grouped by clinical focus. Participants select and report four — one of which must be an applicable MIPS core measure.
| Grouping | Quality measure | Collection type | Core? |
| Stroke Prevention | Q236 — Controlling High Blood Pressure | Part B claims, eCQM, MIPS CQM | Yes |
| Stroke Prevention | Q344 — Rate of CEA or CAS for Asymptomatic Patients | MIPS CQM | No |
| Stroke Prevention | Q438 — Statin Therapy for Cardiovascular Disease | eCQM, MIPS CQM | No |
| Stroke Prevention | Q441 — IVD All or None Outcome Measure (Optimal Control) | MIPS CQM | No (but core) |
| Stroke Care | Q187 — Thrombolytic Therapy | MIPS CQM | No |
| Stroke Care | Q413 — Door to Puncture Time for Endovascular Stroke Treatment | MIPS CQM | No |
| Experience of Care | Q047 — Advance Care Plan | Part B claims, MIPS CQM | Yes |
| Experience of Care | Q495 — Ambulatory Palliative Care Experience (Feeling Heard) | MIPS CQM | No |
Q441 is marked as a core measure in the 2027 guide despite being listed here as an outcome measure. All three core options — Q047, Q236, Q441 — are legitimate picks depending on the clinician’s scope and patient panel.
What happened to Q326?
CMS removed Q326 (Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy) from the 2027 Stroke Care MVP. Participants who reported this measure in 2026 should remove it from their 2027 planning.
The removal shrinks the measure pool from nine to eight. For participants already reporting four measures from the remaining set, the change has no immediate workflow impact.
For anyone whose four-measure plan included Q326, a replacement selection is required before the performance period begins.
How does the core-measure requirement work?
The 2027 rule replaces the prior requirement to report an outcome measure (or a high-priority measure if no outcome measure was available). Instead, participants must include one applicable MIPS core measure among their four reported quality measures.
Three core options
For the Stroke Care MVP, CMS designates three measures as core:
- Q047 — Advance Care Plan
- Q236 — Controlling High Blood Pressure
- Q441 — IVD All or None Outcome Measure
The core measure counts as one of the four — not an additional fifth measure. A participant who reports Q236 as their core measure has three remaining slots to fill from the MVP’s other measures.
When no core measure is applicable
If no core measure is available and applicable to the clinician’s case mix and scope, CMS requires an attestation to that effect and the selection of another MVP measure instead.
“Applicable” is not about whether the measure exists in the set (all three are listed) — it is about whether the clinician’s practice actually has patients who meet the measure denominator.
A vascular surgeon with no primary-care panel may have difficulty satisfying Q236’s denominator. Q047 could work for almost any practice that conducts advance care planning discussions.
The core-measure decision should be based on actual patient population alignment, not on which measure sounds most relevant to stroke care.
Small-practice exception
Small practices (15 or fewer clinicians) are exempt from the 2027 core-measure requirement and do not need the related attestation.
CMS guidance says small practices reporting MVPs through Medicare Part B claims meet the quality requirement by reporting all Part B claims measures available in their selected MVP, even when fewer than four are available.
What does the cost component look like?
The Stroke Care MVP includes one cost measure: COST_IHCI_1 — Intracranial Hemorrhage or Cerebral Infarction. CMS calculates performance using administrative claims data. Participants do not submit a separate cost file.
Cost scoring depends on CMS’s applicable case-minimum and scoring criteria. A clinician or group whose attributed population does not meet the case minimum will not receive a cost score for this measure — which can affect the overall MVP performance calculation.
The practical reality for many stroke-care clinicians is that cost scoring only kicks in with sufficient volume. Smaller practices or subspecialists with narrow referral patterns may find their cost component effectively silent — neither helping nor hurting their overall MIPS score.
How do the population health measures work?
CMS calculates two foundational claims-based measures for every MVP:
- Hospital-Wide 30-Day All-Cause Unplanned Readmission Rate
- Risk-Standardized Hospital Admission Rate for Patients with Multiple Chronic Conditions
If the participant meets the case minimum for both, CMS assigns the higher-scoring measure to the quality score. The participant does not select between them — CMS makes the calculation and picks the more favorable result.
These measures sit in the MVP’s foundational layer and are distinct from the four quality measures the participant selects. They can improve the quality score without requiring additional data submission.
Which improvement activity should participants choose?
MVP participants attest to one improvement activity from the Stroke Care MVP’s list. The options cover a range of care-management, technology, and patient-engagement activities.
| Activity ID | Description |
| IA_AHW_1 | Chronic and preventive care management for empaneled patients |
| IA_BE_1 | Using CEHRT to capture patient-reported outcomes |
| IA_BE_4 | Implementing a patient portal |
| IA_BE_6 | Assessing patient experience and following up |
| IA_BE_24 | Financial navigation |
| IA_BMH_15 | Patient navigation |
| IA_CC_13 | OpenNotes-aligned practice improvements |
| IA_CC_17 | Episodic care management improvements |
| IA_MVP | MVP-specific improvement activity |
| IA_PM_15 | (Listed in the 2027 guide) |
The choice should reflect an activity the practice actually performed during the performance period — not the one with the most appealing title.
CMS requires evidence that the selected activity was conducted according to its specification. Attesting without documentation is a compliance gap that stays hidden until it is not.
For practices already running a patient portal (IA_BE_4) or conducting patient-experience surveys (IA_BE_6), those activities are low-effort attestation targets because the infrastructure already exists.
What about promoting interoperability for MVP participants?
MVP participants submit the same PI measures required under traditional MIPS unless they qualify for PI-category reweighting.
The 2027 Stroke Care MVP guide marks Electronic Prior Authorization as optional — that is a PI measure, not one of the stroke quality measures.
PI scoring and requirements for 2027 are covered in detail in our [MIPS Promoting Interoperability article](internal: mips-pi-2027).
The relevant check here is whether the clinician qualifies for reweighting based on status (hospital-based, non-patient-facing, small practice, etc.) — which would change the PI category’s weight in the MIPS final score without changing the MVP quality reporting.
Who should consider the stroke care MVP?
CMS identifies several specialties that may want to consider this pathway:
- Neurology
- Neurosurgical
- Vascular surgery
- Nurse practitioners
- Physician assistants
- Clinical nurse specialists
Those are suggested specialties, not eligibility gates.
A clinician in any of these roles should confirm their MIPS eligibility, verify their reporting level (individual, group, or subgroup), and check that the MVP’s measures align with their patient population before committing.
A measure’s presence in the MVP does not mean it fits every participant. Q413 (Door to Puncture Time for Endovascular Stroke Treatment) applies to a narrow clinical scenario. Q187 (Thrombolytic Therapy) targets acute ischemic stroke presentations.
A vascular surgeon whose practice is primarily elective would need to check denominators carefully before selecting either.
What should participants prepare before the performance year?
Registration and data collection should start well before the 2027 performance period, not during it.
Verify eligibility and determine whether reporting applies at the individual, group, or subgroup level.
Choose four measures, including an applicable core measure: Q047, Q236, or Q441.
Check denominators, exclusions, data completeness, case minimums, and submission methods for each measure.
Select one improvement activity and keep supporting evidence of its completion.
Confirm Promoting Interoperability reporting obligations and check whether reweighting eligibility applies.
Register through QPP before the 2027 deadline. Do not assume the 2026 registration deadline carries over.
Small practices using Part B claims reporting should begin collecting claims measures early, following QPP guidance.
The most common planning mistake with MVPs is treating the measure selection as a one-time decision made during registration.
Measure specifications can change between the registration window and the start of the performance year. Verify the final 2027 specifications before operationalizing any data-collection workflow.
Your MIPS measures are only as strong as the claims behind them
MVP reporting depends on accurate claims, correct coding, and timely submission. A missed modifier on a stroke-care claim, a credentialing lapse that delays provider enrollment, or a denial that sits unworked for 90 days can all affect your quality measure performance before you even open the QPP portal.
MedHeave operates as a full revenue cycle department inside your practice.
- First-pass claim rate of 90%+ with modifier and NCCI edit checks
- Denial management with 72-hour response and 80%+ overturn rate
- Credentialing and enrollment management across 10-20+ payers per provider
- Weekly reporting that surfaces billing issues before they reach the performance year deadline
- AAPC-certified coders handling surgical operative notes, bundled services, & global surgery packages
Frequently asked questions
Here are some commonly asked questions on this topic:
CMS removed Q326 (Chronic Anticoagulation Therapy for Atrial Fibrillation/Flutter) from the measure set, reducing the MVP to eight quality measures. The 2027 rule also replaced the prior outcome-measure requirement with a core-measure requirement. Participants must now include one applicable core measure (Q047, Q236, or Q441) among their four reported quality measures. The core measure counts as one of the four — not an extra fifth measure.
The three designated core measures are Q047 (Advance Care Plan), Q236 (Controlling High Blood Pressure), and Q441 (IVD All or None Outcome Measure). Participants must include at least one of these in their four reported quality measures. If no core measure is applicable to the clinician’s case mix, CMS requires an attestation and a substitute measure from the MVP. Small practices (15 or fewer clinicians) are exempt from this requirement.
One. Participants attest to a single improvement activity from the MVP’s list of 10 options. The activity must be performed during the performance period and documented according to CMS’s specification. Options range from patient-portal implementation to chronic-care management to financial navigation. The choice should match what the practice actually did — not what sounds most relevant to stroke care.
Yes. The Stroke Care MVP’s cost measure (Intracranial Hemorrhage or Cerebral Infarction) is calculated from administrative claims. Participants do not submit a separate cost file. CMS applies case-minimum and scoring criteria — if the clinician’s attributed population does not meet the minimum, no cost score is assigned. The same applies to the two population-health measures in the foundational layer.
Yes, with adjusted requirements. Small practices (15 or fewer clinicians) are exempt from the core-measure requirement and do not need the related attestation. CMS guidance says small practices reporting through Medicare Part B claims meet the quality requirement by reporting all available Part B claims measures in their MVP. Check the 2027 reporting instructions for measure availability and submission timing specific to the practice’s situation.
