After hearing alarming reports of physicians facing Merit-based Incentive Payment System (MIPS) penalties of up to 9% in 2024 due to their 2022 MIPS performance, the American Medical Association (AMA) sent a letter to the Centers for Medicare and Medicaid Services (CMS) urging the agency to take action.
Physicians were automatically held harmless from penalties during the 2019, 2020 and 2021 performance periods due to the COVID-19 Public Health Emergency (PHE), and although this information has been publicized, the AMA has serious concerns that MIPS may be unfairly penalizing physician practices—particularly small, independent and rural practices—due to a lack of awareness of the expiration of the automatic COVID-19 flexibilities in 2022.
AMA is also hearing from practices that were historically successful in the program that are now expected to receive a negative payment adjustment in 2024 due to the cost category being calculated and an increase to the performance threshold. Physicians had no way to anticipate and improve their cost performance category score because CMS did not share any data about their attributed measures, their attributed patients and their observed costs until Aug. 2023—more than eight months after the conclusion of the performance period.
AMA requested and offered the following potential solutions to CMS so that physicians are not faced with unprecedented payment adjustments in 2024:
- Extend the Targeted Review period.
- Allow people to claim the COVID-19 extreme and uncontrollable circumstances exception during the extended Targeted Review period.
- Reweight 2022 Cost Category.
- Study and re-evaluate the overall cost category and the associated measures.
AMA will continue to actively advocate with CMS on the projected 2024 MIPS penalties and the need to safeguard physicians from unfair penalties.