Small, rural practices faced disproportionate penalties from CMS’ Merit-based Incentive Payment System in 2025, according to a June 13 report by the American Medical Association.
Here are seven takeaways from the report:
1. A large majority — 86% — of MIPS-eligible physicians avoided penalties in 2025, based on their 2023 data, according to results shared with the AMA as a part of the Medicare Quality Payment Program.
2. Three practice types were overrepresented among the 14% of MIPS-eligible physicians who received a penalty of up to -9% of their Medicare-paid amount of covered services. Almost half — 49% — of solo physicians were penalized, followed by 29% of small practices and 18% of rural practices.
3. Among the penalized practice types, 13% of small practices and 29% of solo practices received the maximum -9% MIPS penalty.
4. The number of qualifying Alternative Payment Model participants that are exempt from MIPS rose to 463,669 in 2023, up from 384,105 in 2022. These participants will receive a 3.5% lump-sum APM incentive payment in 2025.
5. The maximum bonus for MIPS-eligible clinicians who achieved a perfect score is 2.15%. This is lower than the previous year because the $500 million exceptional performance bonus pool expired.
6. There were 541,421 MIPS-eligible clinicians in 2023. Only 20,484 reported via the MIPS Value Pathway and 6,790 received their final score from an MVP. Physicians and other clinicians who were scored based on an MVP did slightly better than participants in traditional MIPS. Most MVP reporters also reported in traditional MIPS, and only received the MVP score when it was higher than the traditional MIPS score.
7. APM entities in MIPS continue to receive higher scores than other participants. According to the AMA, this is because they are exempt from the cost performance category, which in 2023 had an average score of 61%, compared with a 75% average score in the quality performance category.
