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The Medicare Merit-Based Incentive Payment System (MIPS) affects reimbursement for nearly all U.S. clinicians via penalties and bonuses for performance across several cost and quality measures. However, clinicians and policy experts have questioned the relevance of MIPS scores to measuring actual clinical performance. Investigators explored associations between MIPS scores and clinical performance in a cross-sectional study that involved 80,000 primary care physicians who cared for 3.4 million patients. MIPS scores were classified as low (≤30), medium (>30–75), or high (>75), and performance was measured on five clinical process measures (e.g., eye exam for patients with diabetes, glycosylated hemoglobin testing, breast cancer screening), s…