CMS to hold physicians harmless from unfair evaluations in the MIPS cost category

May 21, 2021

On Thursday, May 20, 2021, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS) Cost Performance Category will be reweighted for the 2020 reporting period to 0% of the final score, even if eligible physicians or groups submitted 2020 data in other MIPS categories in light of the impact of the COVID-19 pandemic.

For over a year, the California Medical Association (CMA), American Medical Association (AMA) and others have been recommending that CMS zero out this category during the pandemic for several reasons, including concerns that decreases in patient visits and increases in the costs of caring for patients with COVID-19 could unfairly penalize physicians. We applaud CMS for holding physicians harmless from unfair evaluations in the MIPS Cost Performance Category as a result of the COVID-19 pandemic.

CMS also announced it would release the 2018 and 2019 cost measure benchmark files. AMA has been urging CMS to release the MIPS cost benchmarks to increase transparency in how the agency evaluates physician performance in the Cost Performance Category in MIPS and to allow physicians and other stakeholders to assess the measures for validity and opportunities to reduce spending. AMA and other stakeholders will now be able to closely review the files to identify the target spending for those years, how the benchmarks capture any variations in spending, and whether the benchmarks are leading to fair and valid comparisons among physicians.




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