What is the Cost performance category of MIPS and how is it scored in 2018?

What is the Cost performance category included in MIPS?

Measuring cost is an important part of MIPS because cost measures show:

  • The resources clinicians use to care for patients.
  • The Medicare payments (for example, payments under the Physician Fee Schedule, IPPS, etc.) for care (items and services) given to a beneficiary during an episode of care. An episode of care is the basis for finding items and services from claims given in a specified timeframe.

What are Cost Measures?

For 2018, MIPS uses cost measures that cover the total cost of care during the year or during a hospital stay. The Cost performance category uses your Medicare claims data to collect Medicare payment information for the care you gave to beneficiaries during a specific period of time. Because CMS uses Medicare claims data, they will calculate the Cost performance category score and you don’t have to submit any data.  

For the 2017 transition year, the Cost performance category didn’t count toward your total MIPS score. In year 2, it counts for 10% of your total MIPS score. CMS believes that the 10% cost weight in 2018 will help you:

  • Have an easier transition to the 30% cost weight MACRA requires starting with the 2019 MIPS performance period.
  • Review and understand your performance cost measures.

If you participate in a MIPS Alternative Payment Model (APM), the MIPS APM will apply a 0% weight to the Cost performance category because many MIPS APMs measure cost in other ways.

What are the Year 2 Cost Measures?

In year 2, CMS will only use two cost measures to measure performance:

  • Total Per Capita Cost measure
  • Medicare Spending Per Beneficiary measure

Details about the Total Per Capita Cost (TPCC) Measure for MIPS

The TPCC measure measures all of Medicare Part A and Part B costs during the MIPS performance period. For the TPCC measure, beneficiaries are assigned to a single Medicare Taxpayer Identification Number/National Provider Identifier (TIN-NPI) in a two-step process that considers:

  • The level of primary care services they received (as measured by Medicare allowed charges during the performance period). 
  • The clinician specialties that performed these services. 

Only beneficiaries who received a primary care service during the performance period are assigned to the TIN-NPI. Primary care services include:

  • Evaluation and management services given in office and other non-inpatient and non-emergency-room settings
  • Initial Medicare visits and annual wellness visits.

Here are the two steps used to assign beneficiaries to a TIN-NPI for the TPCC measure:

  1. If a beneficiary received more primary care services (PCS) from primary care physicians (PCPs), nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists CNSs) in tat TIN-NPI than in any other TIN-NPI or CMS Certification Number (CCN), the beneficiary is assigned to the TIN-NPI in the first step.

    1. If the beneficiary received more PCS from CPCs, NPs, PAs, and CNSs from a CCN than any other TIN-NPI, this beneficiary:

      1. Would be assigned to the CCN

      2. Wouldn’t be assigned to any TIN-NPIs.

      3. Would be excluded from risk adjustment.

    2. If two TIN-NPIs tie for the largest share of a beneficiary’s primary care services, the beneficiary will be assigned to the TIN-NPI that last gave primary care services.

  2. If the beneficiary did not receive primary care service from any PCP, NP, PA, or CNS during the performance period and received more primary care services from non-primary care physicians within the TIN-NPI than in any other TIN-NPI or CCN, the beneficiary is assigned to a TIN-NPI in the second step.

See the CMS Cost performance category fact sheet for additional details on the TPCC measure.

Details about the Medicare Spending Per Beneficiary (MSPB) Measure for MIPS

The MSPB clinician measure determines what Medicare pays for services performed by an individual clinician during an MSPB episode: the period immediately before, during, and after a patient’s hospital stay.

An MSPB episode includes all Medicare Part A and Part B claims during the episode, specifically claims with a start date between three days before a hospital admission (the “index admission” for the episode) through 30 days after hospital discharge.

The MSPB measure is assigned to individual clinicians, as identified by their unique TIN-NPI. MSPB measure performance may be reported at either the clinician (TIN-NPI) or the clinician group (TIN) level.

How are Cost Measures calculated in 2018?

Cost measures are risk adjusted to account for differences in beneficiary-level risk factors that can affect quality outcomes or medical costs, regardless of the care provided. The goal of risk adjustment is to enable more accurate comparisons across Medicare Taxpayer Identification Number (TINs) that treat beneficiaries of varying clinical complexity, by removing differences in health and other risk factors that impact measures outcomes but are not under the TIN’s control.

How will I get Performance Feedback?

You may have already been getting feedback for several years on cost measures from the Value Modifier program reports and the Physician Feedback Program, Quality and Resource Use Reports (QRURs). In 2018, CMS will give you feedback on cost measures used in the 2017 MIPS transition year. Although the Cost performance category doesn’t affect your payments for the transition year, CMS will still give you performance feedback to help you get familiar with cost measures.

How will I be Scored?

CMS will calculate your Cost performance if the case minimum of attributed beneficiaries (i.e., 20 cases for total per capita cost measure, or 35 cases for MSPB measure) is met. If the case minimums aren’t met for either of the 2 measures, CMS will reweight the Cost performance category weight to the Quality performance category. This will make the Quality performance category worth 60% of your 2018 MIPS total score.

To determine your Cost performance category score, CMS will:

  • Assign 1 to 10 points to each measure
  • Compare your performance to other MIPS eligible clinicians’ and groups’ during the performance period, not on a past year.

The Cost performance category score is the average of the 2 measures, but if only 1 measure can be scored, that score will be the performance category score. The table below illustrates scoring for an example group participating in MIPS.

This group’s Cost performance category is (14.6/20) which is equal to a cost performance category percentage score of 73%. Because the cost performance category is worth 10 points in the MIPS final score, this group would earn 7.3 points towards their MIPS final score.

More information

  • Access the CMS Fact Sheet for 2018 MIPS Cost Performance Category here.
  • Access the CMS Fact Sheet for 2018 Quality Payment Program reporting Year 2 here.
  • CMS also provides further resources for 2018 Quality Payment Program here.

Quality Payment Program

  1. 2018 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  2. What is the MIPS Dashboard watch list and how do I use it?
  3. How does the MIPS Dashboard work?
  4. What is the Promoting Interoperability (formerly Advancing Care Information) performance category in MIPS?
  5. 2018 What is the Quality performance category in MIPS?
  6. 2018 What are Improvement Activities in MIPS?
  7. Which Improvement Activities qualify for the Promoting Interoperability performance category bonus in 2018?
  8. What is the Cost performance category of MIPS and how is it scored in 2018?
  9. How is the MIPS Final Score Calculated in 2018?
  10. What is a MIPS eligible clinician in 2018?
  11. MIPS for Small, Rural and Underserved Practices
  12. 2018 PI Transition Measure: Medication Reconciliation
  13. 2018 PI Transition Measure: Electronic Prescribing (eRx)
  14. 2018 PI Transition Measure: Secure Messaging
  15. 2018 PI Transition Measure: Security Risk Analysis
  16. 2018 PI Transition Measure: Health Information Exchange
  17. 2018 PI Transition Measure: Immunization Registry Reporting
  18. 2018 PI Transition Measure: Specialized Registry Reporting
  19. 2018 PI Transition Measure: Syndromic Surveillance Reporting
  20. 2018 PI Transitional Measure: View, Download, or Transmit (VDT)
  21. 2018 PI Transition Measure: Provide Patient Access
  22. 2018 PI Transition Measure: Patient-Specific Education
  23. What is the Practice Fusion QCDR?
  24. 2017 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  25. How do I report my 2017 MIPS data to CMS using the Practice Fusion QCDR?
  26. What is the Advancing Care Information (ACI) Performance Category for MIPS and how is it scored?
  27. 2017 ACI Transition Measure: Security Risk Analysis
  28. 2017 ACI Transition Measure: Electronic Prescribing (eRx)
  29. 2017 ACI Transition Measure: Provide Patient Access
  30. 2017 ACI Transition Measure: Health Information Exchange
  31. 2017 ACI Transition Measure: View, Download, or Transmit (VDT)
  32. 2017 ACI Transition Measure: Patient-Specific Education
  33. 2017 ACI Transition Measure: Secure Messaging
  34. 2017 ACI Transition Measure: Medication Reconciliation
  35. 2017 ACI Transition Measure: Immunization Registry Reporting
  36. 2017 ACI Bonus Measure: Syndromic Surveillance Reporting
  37. 2017 ACI Bonus Measure: Specialized Registry Reporting
  38. What is the Improvement Activities Performance Category for MIPS?
  39. What are the Quality performance category reporting requirements for MIPS?
  40. What is the difference between the two Advancing Care Information measure sets available in 2017?
  41. What are Alternative Payment Models (APMs) and Advanced APMs?
  42. What is Comprehensive Primary Care Plus (CPC+)?
  43. Which Improvement Activities Qualify for the Advancing Care Information (ACI) Bonus Score in 2017?
  44. How do I contact CMS about the Quality Payment Program?
  45. How do I indicate interest in the Practice Fusion QCDR and get my MIPS estimated scores?
  46. Chronic Care Management FAQs
  47. How do I export a JSON file for 2017 MIPS reporting?
  48. How is the MIPS Final Score Calculated in 2017?

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