CMS Reweights MIPS Cost Category to Zero Due to the Pandemic
By Emma Freer

As a result of the ongoing public health emergency, physicians will find some much-needed, if temporary, relief from burdensome reporting requirements under Medicare’s Merit-Based Incentive Payment System (MIPS).

Citing COVID-19’s impact on clinicians, the Centers for Medicare & Medicaid Services (CMS) recently announced it will reweight the MIPS cost performance category from 20% to 0% for all groups and virtual groups for the 2021 performance period, which impacts 2023 payments.

This follows CMS’ previous announcement that it would reweight the cost performance category to 0% for all individual MIPS-eligible clinicians, who will automatically qualify for an exemption for the 2021 performance year due to the agency’s “extreme and uncontrollable circumstances” policy. As a result, all such physicians will avoid a payment penalty in 2023.

Gregory Fuller, MD, a family medicine physician in Keller and newly installed chair of TMA’s Council on Socioeconomics, welcomed the news.

“The cost of care component is something that we’ve spoken against from the beginning because it’s a category that we [as physicians] have no control over,” he said, adding that the pandemic has exacerbated the problem by driving up emergency department visits and hospitalizations. 

Dr. Fuller says this change is especially important for small practices, many of which report being overwhelmed by the constant changes to MIPS and financially strained by the pandemic. But he adds that the reweighting is a temporary fix to a long-standing problem.

“It’ll help for one year,” he said.

As part of the reweighting process, CMS will redistribute the 20% cost performance category weight to other performance categories.

In a March 25 email announcement, CMS said it can’t reliably calculate scores for the MIPS cost measures that would fairly reflect the performance of MIPS-eligible clinicians. For instance, most measures have higher costs at the episode level, especially those related to respiratory disease and COVID-19, according to CMS.

TMA had advocated for similar relief in a September 2020 letter to CMS, commenting on the proposed 2022 Medicare physician fee schedule. CMS ultimately reweighted the cost category for the 2020 performance year, also due to COVID-19.

“We oppose the cost weight being increased … and urge CMS to delay increases to it until the end of the public health emergency,” then-TMA President E. Linda Villarreal, MD, wrote. “Further, TMA cautions CMS that the cost category is administratively burdensome to many physicians, and building further complexities into this category exacerbates the burden.”


Last Updated On

May 04, 2022

Originally Published On

May 04, 2022

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Emma Freer


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Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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