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New research from the Harvey L. Neiman Health Policy Institute found that most Merit-Based Incentive Payment System (MIPS) quality measures designated as “topped out” by the Centers for Medicare & Medicaid Services (CMS) were reported by only a small fraction of eligible physicians, suggesting these measures may not reflect consistently high performance across clinicians.
Topped out measures are capped at 7 points, which reduces the financial upside for reporting high quality. CMS designates measures as “topped out” with the rationale that meaningful improvement is no longer possible.
The study, published today in Health Affairs Scholar, included 643,558 physicians across 37 specialties who reported 275 MIPS quality measures from 2017 through 2023. Of these measures, 137 (49%), or nearly half, were designated as topped out. More than half of topped-out measures were reported by fewer than 5% of physicians in relevant specialties (i.e., eligible physicians) at the time of their topped-out designation, and only 11 topped-out measures were reported by a majority of physicians. The median reporting rate across all topped-out measures was 7.1%.