CMS to reweigh MIPS data for some physicians amid pandemic

The Centers for Medicare and Medicaid Services is giving physician groups participating in its Merit-based Incentive Payment System more time to apply for an extreme and uncontrollable circumstance waiver so that 2021 quality data has less of a chance of negatively impacting their payments.

Physician groups, virtual groups and alternative payment model entities can apply for a waiver until March 31, and if granted, will have their data re-weighted to account for COVID-19 impacts. In addition, if physician groups didn’t submit data, they will not receive a penalty. The previous deadline was on Dec. 31, 2021, but the American Medical Association and others argued that physician groups needed an extension.

“The increase in COVID cases — and increased demands — coincided with the original E&C hardship application deadline at the end of 2021,” said Dr. Gerald E. Harmon, president of the American Medical Association. “As a result, physicians might have missed the opportunity to file for a hardship application and faced a payment adjustment, and the re-opening of the 2021 application period will give physicians, including APM participants, much-needed relief and better ensure they avoid a negative 2023 MIPS payment adjustment.”

The move comes after the agency provided individual physicians with an automatic exemption in November 2021.

Congress established MIPS in 2015 with the intention to improve outpatient outcomes and reduce spending. Providers can pick from a range of measures. Of the1 million clinicians who participated in MIPS’ first year in 2017, 93% received bonuses that were applied in 2019. About 5% of providers received penalties that capped at 4%.

CMS’ decision may signal how they will treat hospital quality and safety data from 2021. The agency waived requirements to submit for 2020, but has remained silent on 2021, when the pandemic hit health systems with additional COVID-19 waves.