The 2022 update to the Merit-Based Incentive Payment System (MIPS) may result in fewer bonuses and more penalties for oncologists, according to a study presented at the 2022 ASCO Quality Care Symposium.

Researchers estimated that the change in MIPS scores from 2018 to 2022 could mean 14.8% more penalties and 42.8% fewer bonuses for oncologists in 2022.

With MIPS, physicians are scored from 0 to 100, based on their performance in various domains, explained Vishal R. Patel, a student at Dell Medical School at the University of Texas at Austin, who presented this research at the symposium.  

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The Centers for Medicare & Medicaid Services uses MIPS scores to assign financial bonuses and penalties, with higher scores corresponding to greater payments. In 2017, cost metrics contributed 0% to the MIPS score, and quality metrics contributed 60%.

“In efforts to control health care costs, the weight of the cost measure has increased sequentially and is now equal to quality in 2022 [30% each],” Patel said. “This gave us an opportunity to study this policy change and the impact of cost in MIPS.”

Patel and colleagues evaluated data from 168,098 physicians, of whom 3.5% were oncologists, from the 2018 MIPS performance year files and calculated projected 2022 MIPS composite scores. (The 2018 data were used because that was the first year that cost metrics were above 0%.)

Of the 5942 oncologists evaluated, 19.8% were medical oncologists, 47.7% were hematologist-oncologists, 21.8% were radiation oncologists, 5.9% were surgical oncologists, and 4.7% were gynecologic oncologists.

In 2018, oncology had the lowest cost scores, and hospital-based medicine had the highest cost scores. Quality scores were similarly high across all specialties.

The estimated change in MIPS scores from 2018 to 2022 was greatest for oncology, followed by obstetrics/gynecology, psychiatry, medical specialties, surgery specialties, primary care, and hospital-based medicine.

The change from 2018 to 2022 resulted in a roughly 5-point decrease in the mean composite score for oncologists. This translates to 14.8% more penalties and 42.8% fewer bonuses in 2022.

The maximum penalty could reach $18,531 per oncologist in 2022, which is a substantial increase from the $4233 maximum in 2018.

“In conclusion, the current cost measures will unfairly financially penalize oncologists in the MIPS,” Patel said. “This could be a conflict of interest if oncologists change clinical recommendations based off of personal revenue.”

Patel suggested that adjusting cost measures by specialty or adopting oncology-specific payment models could solve or prevent these problems.


Patel VR, Gupta A, Hussaini SMQ, et al. Impact of proposed 2022 changes to the Merit-Based Incentive Payment System (MIPS) on oncologist performance and reimbursement. ASCO Quality Care Symposium 2022. Sept. 30 – Oct. 1, 2022. Abstract 6.