Comment on CMS-2026-2377-0002

Re: Comments on Proposed Policy: Defined Topped Out Measure Benchmarks (CY 2027 Performance Period / Merit-based Incentive Payment System) - Reference File Code: CMS-1848-P Introduction As actively practicing clinical providers and MIPS participants utilizing certified Electronic Health Record (EHR) technology, we appreciate the opportunity to comment on the Centers for Medicare & Medicaid Services (CMS) proposed policies regarding Defined Topped Out Measure Benchmarks. Our clinical workflow relies heavily on seamless digital integration, and our practice’s MIPS participation is directly tied to EHR-driven measure reporting. We write today to offer targeted feedback on how the proposed policies affect specialty-specific reporting, particularly within specialized Merit-based Incentive Payment System Value Pathways (MVPs). Background We are commenting on CMS’s proposal to apply alternative benchmarking methodologies—specifically removing the 7-point scoring cap for MIPS core measures that have been topped out for two or more consecutive performance periods and applying a defined topped-out benchmark (with a 10-point maximum). CMS notes that this policy is intended for measures belonging to "specialty sets and MVPs with limited measure choice and a high proportion of topped out measures, in areas that lack measure development, which precludes meaningful participation in MIPS." Additionally, we acknowledge the proposal to publish and maintain these benchmark designations on the QPP website rather than in the Federal Register. Analysis We strongly support CMS’s recognition that topped-out scoring caps penalize providers who operate in specialties with constrained measure availability. However, we urge CMS to expand the subset of measures subject to this alternative benchmarking methodology to include Quality Measure Q130: Documentation of Current Medications in the Medical Record (Collection Type: eCQM/MIPS CQM). Consider the practical constraints faced by practices participating in the Gastroenterology Care MVP: Measure Limitation: Providers reporting via eCQM within this MVP have access to only 4 available eCQMs. Disproportionate Impact of Scoring Caps: Because Q130 is designated as topped-out, clinicians utilizing EHR-based reporting immediately lose access to a 10-point scoring cap on 25% of their available eCQM options within the MVP. Lack of Measure Development: Specialty care lacks alternative, viable eCQM development for broader routine health maintenance. Providers choosing fully integrated digital reporting are forced to accept a capped score (maximum 7 points) on Q130 simply because no alternative eCQM measures exist to replace it. Imposing a 7-point cap on Q130 in this context creates an unintended consequence: it penalizes high-performing gastroenterology practices for utilizing certified EHR technology and attempting meaningful participation in MIPS/MVPs. This directly contradicts CMS’s stated rationale for proposing alternative benchmark scoring. Recommendations To ensure fair and equitable scoring for specialty providers, we recommend that CMS: Include Quality Measure Q130 (eCQM / MIPS CQM) in the specific subset of measures receiving the defined topped-out measure benchmark methodology (10-point maximum) beginning in the CY 2027 performance period. Apply Alternative Benchmarks to Constrained MVPs: Automatically grant alternative benchmark methodology to any topped-out eCQM/CQM when it is embedded in an MVP that offers 5 or fewer total collection-type measures for that specialty, preventing artificial caps on Quality Category performance. Conclusion CMS correctly identified that limited measure selection in specialized fields undermines meaningful participation in MVPs. For gastroenterology providers reporting via eCQM, the 7-point cap on Quality Measure Q130: Documentation of Current Medications in the Medical Record poses an insurmountable scoring barrier because only 4 eCQMs are available in the Gastroenterology Care MVP. We respectfully request that CMS include Q130 in the subset of measures designated for the defined topped-out benchmark methodology to allow high-performing practices a fair path toward full scoring potential. Thank you for your time and consideration of these comments.