A Long-Overdue Recognition for Screening
Tardive dyskinesia (TD) is a serious, often irreversible drug-induced movement disorder caused by prolonged use of antipsychotic and other dopamine-blocking medications. Despite affecting an estimated 15-50% of patients on antipsychotics, TD remains underdiagnosed – approximately 60% of individuals living with the condition have never received a formal diagnosis. Most patients are unaware that their medication could cause TD. A 2021 clinical audit found fewer than 3 in 10 patients starting antipsychotics received any documented information about movement-related side effects. Yet those who did discuss TD with their physician or clinician were 32 times more likely to receive a diagnosis.
CMS Takes Action: The 2026 Physician Fee Schedule
In October 2025, CMS issued the Calendar Year 2026 Medicare Physician Fee Schedule Final Rule, which includes a substantial modification urging clinicians to close the TD-screening gap.
Central to this ruling is an update to the MIPS Improvement Activity IA_BMH_1, detailed on pages 50359–50362 of the Final Rule. The title changes from “Diabetes Screening” to “Antipsychotic-Medication-Associated Physical Health Condition Assessment and Monitoring.” It is no longer limited to patients with schizophrenia or bipolar disorder. Screening now covers all patients on antipsychotics regardless of diagnosis.
As part of its rationale, CMS acknowledged clinical guidelines from four medical associations covering movement disorders, obesity, hypertension, and dyslipidemia, listing lab tests and physical screenings as standard care to reduce morbidity, mortality, and financial burden. AIMS-based movement assessment is explicitly included alongside cardiometabolic and family history screenings.
CMS also cited critical gaps: AIMS and TD screening documentation is nearly nonexistent in outpatient practice, and cardiometabolic monitoring falls well short of standards. It also explicitly referenced the TD cost burden: TD patients have higher inpatient rates (55.5% vs. 26.1%), ER visits (61.5% vs. 50.6%), and total costs ($54,656 vs. $28,777) than those without TD.
Their justification is more relevant given that antipsychotic use is rising and extending well beyond behavioral health. Primary care physicians prescribe over 60% of antipsychotics in rural areas and nearly half in urban settings. A 2026 JAMA Network Open study found that APRNs and PAs – clinicians even less likely to have movement disorder training – have become the largest antipsychotic-prescribing group, tripling their share from 13.8% to 39.6% between 2013 and 2023, further widening the gap between prescribing volume and monitoring practice.
What the Revised Activity Requires
Under revised IA_BMH_1, MIPS-eligible clinicians must implement at least one process improvement for monitoring key health indicators, including metabolic factors (BMI, blood pressure, glucose, lipids, weight/family history) and movement disorders assessed via tools like the AIMS. Improvements must include at least one of:
(1) educational materials or training on monitoring protocols (e.g., AIMS training);
(2) standardized collection and documentation of key health indicators (e.g., EHR reminders); or
(3) collaborative service agreements with enhanced monitoring services to adjust medications or refer patients for further assessment (e.g., AIMS). These activities apply to primary care physicians, psychiatrists, neurologists, and other clinicians prescribing or monitoring antipsychotics.
How Amalgam Rx Can Help
Each activity pathway maps directly to an Amalgam solution.
- For educational materials: Amalgam’s AIMS Training Website equips clinical teams to conduct proper AIMS assessments.
- For standardized collection and documentation: Amalgam’s AIMS CDS solution identifies patients due for assessment and delivers point-of-care reminders in the EHR. The AIMS Assessment Application (eAIMS) supports assessments with guided and expert modes, trend analysis, and PDF documentation written to the patient’s record – integrated with Athena, AdvancedMD, and PointClickCare EHRs, with a standalone version. Research shows EHR-integrated tools can lift AIMS documentation from 3% to 87%.
- For collaborative agreements: Amalgam’s solutions make it easier to implement coordinated care and ensure MIPS attribution.
A Call to Action for all patients
CMS’s modification to IA_BMH_1 is a meaningful first step, but its reach is limited to Medicare. The standard of care it codifies should apply to every patient on antipsychotic medication, regardless of payer or diagnosis. With an estimated 800,000 Americans living with TD and 6 out of 10 undiagnosed, the monitoring gap is both a quality-of-care crisis and a preventable cost burden. It’s something no practice should ignore.
Connect with Amalgam. Our AIMS clinician training, point-of-care reminders, and screening solutions will help your organization meet MIPS requirements and ensure every patient on antipsychotic medication receives the monitoring they deserve.
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