Internal medicine occupies a unique position within the Merit-based Incentive Payment System (MIPS). Compared to family medicine, internists typically care for older patients with greater clinical complexity, presenting with multiple chronic conditions such as diabetes, heart failure, coronary artery disease, and chronic kidney disease that often coexist in the same patient. Such complexity should be an advantage within the MIPS framework, not a disadvantage, but this is only the case if the selection of measures truly reflects it. Opting for measures designed for a general primary care population, rather than those addressing the comprehensive chronic disease management characteristic of internal medicine practice, is one of the most common reasons why internal medicine practices achieve results that fall short of the actual quality of care they provide. The following section explains how to approach measure selection for the 2026 performance year under the CMS Quality Payment Program (QPP).

The Core Requirement: Six Measures, One Outcome or High Priority

Under the traditional MIPS program, the Quality category which accounts for 30% of your final score requires the selection of six measures; at least one must be classified as an outcome measure or another high-priority measure (a category encompassing measures of appropriate use, patient experience, patient safety, efficiency, and care coordination). CMS evaluates your performance against national benchmarks using eligible encounters recorded throughout the entire performance year across all payers; therefore, the selection of measures must balance clinical relevance with the actual volume of eligible patients seen by your practice.

Strong Measure Options for Internal Medicine in 2026

Hemoglobin A1c (HbA1c) Poor Control (Measure #1): It tracks the percentage of diabetic patients aged 18 to 75 whose most recent A1c level exceeded 9% or who did not undergo testing during the period. This is one of the most well-established outcome measures and is particularly suitable for the diabetic population typically a large group seen in internal medicine departments; furthermore, it meets the high-priority outcome measure requirement applicable to most medical centers.
 

Diabetes: Eye Exam (Retinopathy Screening): It tracks whether diabetic patients underwent a retinal or dilated eye exam during the measurement period or within the preceding 12 months for patients without diagnosed retinopathy. This measure naturally complements HbA1c monitoring in centers serving a significant diabetic patient population, thereby reinforcing a coordinated approach to chronic disease care across their suite of indicators.
 

Diabetes: Kidney Health Evaluation: It tracks whether diabetic patients aged 18 to 85 underwent both an estimated glomerular filtration rate (eGFR) assessment and a urine albumin-to-creatinine ratio (uACR) determination during the evaluation period. Monitoring renal function is a standard part of diabetes management in internal medicine, and this indicator tracks a screening test that most centers already document.
 

Heart Failure: ACE Inhibitor, ARB, or ARNI Therapy: It tracks whether patients with heart failure and reduced ejection fraction (LVEF ≤ 40%) were prescribed guideline-recommended treatment, either in an outpatient setting or upon hospital discharge. For internal medicine departments treating a significant population with cardiology-related conditions, this measure reflects a highly significant aspect of clinical management, rather than a mere routine screening procedure.
 

Coronary Artery Disease: Antiplatelet Therapy: It tracks whether patients with coronary artery disease were prescribed aspirin or clopidogrel within a 12-month period. Together with the previously mentioned heart failure indicator, this completes a set of cardiovascular-focused measures that leverages the characteristics of an internal medicine population with a higher prevalence of cardiac comorbidities.
 

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented: Track blood pressure screenings and the documented follow-up plans based on the results obtained. Hypertension management is a central aspect of most internal medicine consultations, making this measure a high-volume, low-operational-complexity option for systematic reporting.
 

Colorectal Cancer Screening (Measure #113): It tracks the percentage of patients aged 45 to 75 with documented and reviewed colorectal cancer screening results, using any method accepted by CMS (colonoscopy, FIT, FOBT, CT colonography, or stool DNA test within the appropriate timeframe). This is a robust preventive care measure for the older adult population served in internal medicine and typically involves a significant volume of eligible encounters.
 

Preventive Care and Screening: Mammography: It tracks whether women aged 40 to 74 have undergone a screening mammogram within the last 27 months. In internal medicine practices with a significant proportion of adult female patients, this preventive measure typically yields a sufficient denominator volume to allow for reliable reporting.
 

Build Around Your Actual Panel, Not a Generic Template

The measures mentioned above cover diabetes, cardiovascular disease, and cancer screening, as these conditions are prevalent in a typical internal medicine practice; however, your medical practice may not be "typical." A practice with a high proportion of geriatric patients or those with multimorbidity might generate far more encounters eligible for kidney health assessment and heart failure-related measures than for cancer screening. Before finalizing your six measures, compare each candidate option against your actual claims history to confirm that you have a sufficient number of encounters meeting the criteria; the goal is to obtain a statistically significant performance rate comparable to benchmarks, rather than simply a measure that appears clinically appropriate.

Watch for the 2026 Inventory Changes

For the 2026 performance year, CMS has finalized the addition of 5 new quality measures, substantial changes to 30 existing measures, and the removal of 10 measures from the MIPS inventory. If your practice has reported the same six measures for several consecutive years, do not assume that this year’s specifications match those of the previous year. A measure that was reliable in 2025 might feature updated denominator criteria, a revised benchmark, or in some cases have been completely retired for 2026.

Consider an MVP as the Long-Term Direction

Starting with the 2026 performance year, internal medicine practices may choose to report data via a MIPS Value Pathway (MVP) instead of the traditional MIPS system. MVPs group together a set of measures that are more specific and relevant to the specialty, thereby reducing the administrative burden of selecting measures from the full internal medicine set each year. Although MVPs remain optional for 2026, CMS has made it clear that they represent the program's future direction; for internists treating patients with complex clinical presentations and multiple conditions, an MVP’s integrated structure may be easier to align with actual patient care than the task of independently selecting six measures each reporting year.

Improvement Activities Worth Pairing With Your Measures

Improvement activities account for 15% of your total score, and selecting activities that reinforce your chosen quality measures strengthens your overall reporting profile. For an internal medicine measure set focused on chronic diseases, activities such as care coordination agreements with specialists, the use of prescription drug monitoring programs prior to prescribing controlled substances, or structured medication reconciliation processes complement measures related to diabetes and cardiovascular disease particularly well.

The Takeaway

The complexity of internal medicine patients offers a distinct advantage under the MIPS program; measures related to chronic conditions such as HbA1c control, kidney health assessment, and heart failure management are precisely the areas where a well-managed internal medicine practice should excel. The mistake to avoid is defaulting to a generic set of preventive care measures that fails to accurately reflect the actual clinical management your practice provides on a daily basis. Reviewing your claims history against these measure options before the performance year is too far underway and confirming that this year’s specifications haven't changed unexpectedly gives your practice the best chance of achieving a 2026 score that truly reflects the care you deliver.

ESOFTX, Inc. offers MIPS reporting services and is a trusted provider in this field, helping internal medicine and primary care practices select, monitor, and accurately report MIPS quality measures. If you would like a claims-based review of your measure selection for 2026, our MIPS consultants would be happy to assist you.