Oct. 6, 2023: Medicare Payment Reform Advocacy Update

. 4 MIN READ

On Aug. 10, the Centers for Medicare & Medicaid Services (CMS) made available 2022 MIPS performance feedback, which determines whether physicians will receive a positive, neutral or negative payment adjustment on Medicare services furnished in 2024.

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    The AMA has heard alarming reports of physicians facing MIPS penalties in 2024 for the first time since the program started. The AMA is advocating to CMS and to physicians to address this situation with the goal of mitigating the potential financial implications for physician practices. More information can be found in the following two stories.

    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 AMA sent a letter (PDF) to the CMS Administrator 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.  

    The 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. The AMA requested and offered the following potential solutions to CMS so that physicians are not faced with unprecedented payment adjustments in 2024: 

    1. Extend the Targeted Review period. 
    2. Allow people to claim the COVID-19 EUC during the extended Targeted Review period. 
    3. Reweight 2022 Cost Category. If not feasible, zero out TPCC and MSPB from 2022 calculations. 
    4. CMS should study and re-evaluate the overall cost category and the associated measures. 

    The AMA will continue to actively advocate to CMS on the projected 2024 MIPS penalties and the need to safeguard physicians from unfair penalization. If any policy changes occur, the AMA will publicize the news immediately. 

    The AMA strongly encourages physicians to view their 2022 MIPS performance feedback as soon as possible for two reasons: 

    1. If there are any errors, you should consider submitting an appeal, also called a targeted review. For more information about how to request a targeted review, please refer to the 2022 Targeted Review User Guide (PDF). The deadline to submit a targeted review is Oct. 9, 2023. 
    2. You can help the AMA advocate against Medicare physician payment cuts in 2024 by sharing this information. If you feel comfortable, you can share de-identified score and corresponding payment adjustment information. This will inform the AMA’s understanding of the impact of MIPS on physician payment in 2024 and can help in conversations with the administration and Congress about ensuring physician payment supports high-quality care to Medicare patients. Please share your information by emailing the AMA Advocacy staff at [email protected].  

    Physicians can view their 2022 MIPS Performance Feedback information on the Quality Payment Program (QPP) website using their HCQIS Access Role and Profile (HARP) credentials. The CMS Payment Adjustment User Guide (PDF) walks through the process of accessing and downloading performance feedback. 

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