Editor's note: This story has been updated to reflect the new exemption application window. The prior version, published March 21, reported on the AMA's letter.
The Centers for Medicare & Medicaid Services (CMS) is offering physician practices additional leeway on their 2024 quality reporting in light of a national shortage of IV fluids.
The change comes shortly after a petition from the American Medical Association (AMA) asking the agency for grace, which noted that many providers are still wrangling the shortages.
The CMS' webpage for Quality Payment Program (QPP) exemptions now includes a notice and fact sheet informing providers that the deadline for data submission has been pushed back from March 31 to April 14. The agency noted that the extension does not apply to certain opt-in eligible clinicians and groups, or to Alternative Payment Model entities electing to participate in the Merit-based Incentive Payment System (MIPS).
Additionally, the window to apply for a MIPS Extreme and Uncontrollable Circumstances (EUC) exemption, which had closed on Dec. 31, will reopen on March 31 through April 14. The exemption application allows providers to request reweighing of any or all performance categories due to circumstances outside of their control.
For the exemption, the CMS stressed in the fact sheet that it "will only accept applications citing the shortage as the basis for requesting reweighting under the MIPS EUC Exception. Any applications submitted for reasons outside of the national IV fluid shortage will be denied."
The IV shortage was fueled by September’s Hurricane Helene, which sidelined production at a major manufacturing plant for about a month and a half. Providers reported at the time that the interruption in supply was forcing procedure cancellations and other rationing strategies through the end of the year.
In a March 12 letter, AMA told the CMS that the mitigation efforts could affect some physicians’ performance in MIPS, the quality program that can impact their Medicare Part B reimbursements,
Specifically, AMA CEO and Executive Vice President James Madara, M.D., raised concerns that MIPS quality and cost measures during the 2024 performance year “may be impacted due to circumstances outside of their control. Physicians should not be forced to choose between preserving their performance in MIPS or appropriately rationing critical medical supplies during the current emergency situation.”
The CMS had recently permitted physicians to make use of the exemption in light of the COVID-19 pandemic and in 2024 with the Change Healthcare cyberattack, with the application window for the latter closing Dec. 31.
The agency’s flexibility during those “catastrophic” events lightened private practice physicians’ regulatory burdens and helped maintain access to care, the AMA said in its March 12 letter. Those same goals, it wrote at the time, should again be considered for the IV fluid shortage and its contingency efforts—which the AMA noted are still in effect thanks in part to this winter’s “severe” levels of respiratory virus cases.
“Practices that would otherwise have been able to divert clinical or administrative staff time to apply for an EUC hardship exception or submit MIPS data are currently unable as they manage new and evolving processes to avoid patient delays by conserving limited IV fluid supplies, managing existing supplies and investigating alternative supply chains,” the AMA’s Madara wrote.
The CMS' similarly called out the added administrative burden, writing in this week's fact sheet that providers "may need to apply [for the exemption] if your practice’s administrative and support staff has needed to focus on supply chains to support patients’ care, affecting their capacity to collect and prepare data for reporting."
The CMS noted in the fact sheet that the deadline exemption will delay the release of final scores and opening of Targeted Review, for which it normally targets mid-June. It also warns that any performance categories for which it already has received data from providers won't be reweighted.
"However, if three of the performance categories are reweighted to 0% and only one performance category can be scored (e.g., because the MIPS eligible clinician, group, or virtual group submitted data for that category), then the MIPS eligible clinician, group, or virtual group will earn a final score equal to the performance threshold and the MIPS eligible clinician(s) will receive a neutral payment adjustment," the CMS wrote in its fact sheet.
Eligible providers may apply for the MIPS EUC exemption through their QPP website login.