Oncologists participating in the Merit-Based Incentive Payment System (MIPS) may be disproportionately penalized because the weight of cost measures has increased, according to researchers. 

The researchers performed simulations that showed the recent increase in the weight of cost measures (from 0% in 2017 to 30% in 2022), combined with lower cost scores, will likely result in lower composite MIPS scores, fewer total payment bonuses, and greater negative payment adjustments for oncologists.

These findings were published in JCO Oncology Practice.

The researchers explained that, with MIPS, physicians receive financial rewards or penalties based on performance. MIPS participants are evaluated on cost (the dollar amount spent on inpatient or outpatient care) and quality as assessed by outcomes and processes associated with providing effective, patient-centered care. 

For this study, the researchers first identified physicians scored on cost and quality in the 2018 MIPS. The researchers then simulated composite MIPS scores and payment adjustments by applying the 2022 cost-quality weights to the 2018 scores and compared changes across specialties.

Of the 168,098 physicians participating in MIPS, 5942 (3.5%) were oncologists. In adjusted analyses, oncologists had the lowest cost scores and quality scores across specialties. The mean cost score was 61.3 for oncology and 80.2 for hospital-based specialties (difference, –18.94; P <.001). The mean quality score was 82.4 for oncology and 84.3 for hospital-based specialties (difference, –1.92; P =.09).

“We found a strong association between greater patient clinical complexity and lower cost scores; although oncologists took care of patients with higher clinical complexity than other physicians, this finding was not sufficient to explain the lower cost scores among oncologists,” the researchers wrote. 

After the simulated reweighting, when cost measures made up a larger portion of the overall MIPS score, oncologists had the largest decrease in composite MIPS scores. The mean difference was –4.3 for oncology and –1.7 for other specialties. 

The researchers noted that the reduction in composite MIPS scores contributes to 42.8% fewer oncologists and 23.6% fewer physicians outside of oncology receiving an exceptional payment bonus. 

The increase in physicians receiving negative payment adjustments was similar between oncologists and non-oncologists — 14.8% and 14.3%, respectively. 

However, the maximum penalty for oncologists receiving a negative payment adjustment increased more than 4-fold, from –$4233.41 in 2018 to –$18,531.06 in 2022. In non-oncologists, the maximum penalty decreased from –$8262.82 in 2018 to –$7473.57 in 2022.

“[T]he current paradigm of the MIPS scoring system will financially penalize heterogeneous and complex care-driven specialties such as oncology,” the researchers wrote. “It may be prudent to monitor whether the potential loss in revenue results in altered practice patterns and varying degrees of health care quality for patients with cancer.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Patel VR, Cwalina TB, Nortje N, et al. Incorporating cost measures into the merit-based incentive payment system: Implications for oncologists. JCO Oncol Pract. Published online April 24, 2023. doi:10.1200/OP.22.00858

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