May 16, 2025: National Advocacy Update

Based on AMA advocacy, the Center for Medicare & Medicaid Services (CMS) has clarified that physicians and practices can claim a hardship from the Merit-based Incentive Payment System (MIPS) Cost Category and administrative claims measures due to issues that may impact normal practice operations for an extended period, such as a cyberattack.

Individual clinicians, groups and virtual groups (or a third-party representative) can submit a MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application for one or more MIPS performance category (quality, cost, improvement activities, and Promoting Interoperability) due to extreme and uncontrollable circumstances for the 2025 MIPS performance period now through Dec. 31, 2025, at 8:00 p.m. Eastern.   

Such qualifying circumstances are the following: 

• Cause you to be unable to collect information necessary to submit for a MIPS performance category 

• Cause you to be unable to submit information that would be used to score a MIPS performance category for an extended period of time (for example, if you were unable to collect data for the quality performance category for 3 months) 

• Impact your normal processes, affecting your performance on cost measures and other administrative claims measures 

Alternate Payment Model (APM) Entities can submit applications as well, but they must apply for all performance categories. 

To receive a hardship for the Promoting Interoperability, CMS will also consider the following: 

• You have decertified Electronic Health Record (EHR) technology (must be decertified under the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) Health IT Certification Program). 

• You have insufficient internet connectivity. 

• You face extreme and uncontrollable circumstances such as a disaster, practice closure, severe financial distress, or vendor issues. 

• You lack control over the availability of certified EHR technology (CEHRT). 

If your application is approved, you will not be required to report data for the performance category or categories included in your approved application. However, please note that a qualifying data submission will override approved reweighting on a category-by-category basis. Any qualifying data you, or someone on your behalf, submits will be scored, and those performance categories will contribute to your final score. 

CMS recently released the 2023 Quality Payment Program (QPP) Participation and Performance Results At-a-Glance (PDF), which includes high-level metrics on participation, scoring and Medicare payment adjustments resulting from the Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs) for 2023 which affect payments in 2025. Due to AMA advocacy to continue expanded access to hardship exceptions in MIPS in 2023 due to the COVID-19 public health emergency and lobbying to maintain the performance threshold needed to avoid a penalty, 86% of MIPS-eligible clinicians avoided a penalty in 2025 based on performance in 2023. However, MIPS continues to disproportionately harm small and rural practices due to its administrative complexity and burden. Compared to 14% of MIPS-eligible clinicians overall who are receiving a penalty of up to –9% of their Medicare paid amount for covered services as a result of MIPS, 29% of small practices, 49% of solo practitioners, and 18% of rural practices are receiving a MIPS penalty. Of those practices receiving a penalty, 13% of small practices and 29% of solo practitioners are receiving the maximum MIPS penalty of –9%. The AMA is strongly urging (PDF) the Trump administration to make regulatory changes that will help relieve the administrative burden of MIPS and even the playing field for small and rural practices and their patients.  

Additional notable takeaways from the report include:

• The number of Qualifying APM Participants (QPs) who are exempt from MIPS increased from 384,105 in 2022 to 463,669 in 2023. QPs will receive a 3.5% lump-sum APM incentive payment in 2025 due to AMA’s continued advocacy to support physician participation in value-based payment models.   

• The maximum bonus for MIPS-eligible clinicians who received a perfect score is 2.15%, which is lower than the year prior due to expiration of the $500 million exceptional performance bonus pool.  

• There were 541,421 MIPS-eligible clinicians in 2023. Only 20,484 reported via the MIPS Value Pathway (MVP) 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. CMS states that most MVP reporters also reported in traditional MIPS, so they only received the MVP score when it was higher than the traditional MIPS score.  

• APM Entities in MIPS continue to receive higher scores than other participants in large part because they are exempt from the Cost Performance Category.  

CMS indicated that it would release the 2023 QPP Experience Report which includes more detailed information about participation, scoring, and payment adjustments in MIPS and APMs in July. 

The AMA recently sent a letter (PDF) to CMS Administrator Mehmet Oz, MD, applauding his commitment to addressing the burdensome prior authorization (PA) process. Citing years of partnership with state medical associations and national medical specialty societies on this issue, deep policy expertise, credible and widely cited research, and industry consensus-building efforts, the AMA offered to serve as a resource to CMS as it continues efforts to improve PA. The AMA highlighted alignment between organized medicine’s PA reform priorities and those outlined by Dr. Oz in his Senate confirmation hearing, to include reducing the overall volume of PA requirements, improving transparency, protecting continuity of patient care and automating the process. 

In a May 9 court filing (PDF), the Trump administration announced that it intended to reconsider and not enforce parts of the 2024 Mental Health Parity and Addiction Equity Act (MHPAEA) Final Regulation and asked that the case filed against the Department of Health and Human Services (HHS) by the ERISA Industry Committee (ERIC) be placed in abeyance as reconsideration of the regulation proceeds. The Trump administration could modify last year’s final regulation, rescind it, or propose a new rule.  

The AMA asked the Trump administration to vigorously defend the MHPAEA Final Regulation against the ERIC lawsuit in a March 13 letter (PDF) to the Department of Labor, HHS and the Department of the Treasury.   

President Donald Trump signed an update to the MHPAEA into law in 2020, and a new final rule implementing the law was issued in September 2024. The AMA’s March 2025 letter focused on how the final rule further advanced President Trump’s efforts to strengthen the fight against the nation’s overdose and death epidemic and helped improve access to evidence-based mental health and substance use disorder (MH/SUD) care for tens of thousands of Americans.  

The MHPAEA was originally enacted in 2008 and mandated that insurers that cover MH/SUD treat those services similarly to how they treat medical and surgical care. Federal regulations were put in place to implement the MHPAEA’s provisions, including the September 2024 Final Rule (PDF) that made enforcement more straightforward.

The AMA recently expressed support (PDF) for H.R. 2483, the “SUPPORT for Patients and Communities Reauthorization Act of 2025” (SUPPORT Act), which passed favorably out of the House Committee on Energy and Commerce on April 29. Introduced by Reps. Brett Guthrie (R-AL) and Brittany Pettersen (D-CO), this legislation would increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD) through the reauthorization of several important policy programs. This legislation is crucial as many provisions enacted as part of earlier versions of the SUPPORT Act have expired, thus necessitating expeditious congressional action on new legislation reauthorizing these programs. It is unclear at this time when the full House of Representatives will schedule a vote on the passage of legislation. 

“In recent years we have witnessed strong growth in harm reduction services and policy advancements to remove barriers to evidence-based support for OUD that enable physicians to provide the best level of care for patients battling addiction,” wrote AMA CEO and EVP James L. Madara, MD. “The SUPPORT Act and other efforts to increase access to medications for opioid use disorder (MOUD)—along with broad access to naloxone—are two important factors why overdose deaths have decreased over the past year.” 

The AMA continues to urge expeditious passage of H.R. 2483 and for policymakers to continue to eliminate unnecessary barriers to SUD patient care, harm reduction, and evidence-based pain care. Learn more about the AMA’s efforts to end the nation’s drug-related overdose epidemic.

A May 7 report from the Healthcare and Public Health Sector Coordinating Council (HSCC) Cybersecurity Working Group describes the challenges that physician practices as well as other resource-constrained health care providers face in terms of managing cybersecurity protections in their offices and other facilities. The HSCC report, On the Edge: Cybersecurity Health of America’s Resource-Constrained Health Providers (PDF), cites limited workforce and expertise, outdated systems and insufficient funding as the primary reasons for the challenges that many providers face.

The HSCC Cybersecurity Working Group is a government-recognized critical-infrastructure industry advisory council of more than 460 health care providers, pharmaceutical and medical technology companies, payers, health IT developers and other entities. 

Summarizing interviews with 40 executives of small, rural and critical access providers, along with federally qualified health centers and skilled nursing facilities in 30 states across the country, the report explores how these entities approach their cybersecurity responsibilities and what kind of government and community support would be meaningful to strengthening their cyber health. The report calls on government and the broader health care community to support workforce augmentation, financial resources, and partnerships to enhance cybersecurity and protect patient safety.

The AMA has many cybersecurity resources available to physicians on its Physician Cybersecurity page. Also, watch this AMA Advocacy Insights webinar to learn about how to implement appropriate cybersecurity measures to protect your practice as well as your patients against the cybersecurity challenges of today, as well as hear about advocacy that is underway to strengthen cybersecurity systems and provide support to physician practices for enhancing their cyber hygiene.

CMS is suspending eight improvement activities for the 2025 MIPS performance year. CMS intends to propose removing these improvement activities in future rulemaking. Physicians should select other improvement activities to complete. However, if any of the suspended improvement activities have already been completed or were in the process of being completed, clinicians will still be able to attest to completing them and receive credit. Please review the 2025 Improvement Activities Inventory for available improvement activities. Visit the QPP website for more information. 

MIPS improvement activities suspended for PY 2025 

• IA_AHE_5: MIPS Eligible Clinician Leadership in Clinical Trials or CBPR 

• IA_AHE_8: Create and Implement an Anti-Racism Plan 

• IA_AHE_9: Implement Food Insecurity and Nutrition Risk Identification and Treatment Protocols 

• IA_AHE_11: Create and Implement a Plan to Improve Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients 

• IA_AHE_12: Practice Improvements that Engage Community Resources to Address Drivers of Health 

• IA_PM_6: Use of Toolsets or Other Resources to Close Health and Health Care Inequities Across Communities (Use of toolset or other resources to close health care disparities across communities) 

• IA_ERP_3: COVID-19 Clinical Data Reporting with or without Clinical Trial 

• May 16, 2025: Medicare Payment Reform Advocacy Update
• May 16, 2025: State Advocacy Update