This content was excerpted from EyeNet’s MIPS 2019; also see the Academy’s MIPS hub page.
Cost is one of four performance categories that can contribute to your MIPS final score.
The cost performance category is weighted at 15% of your MIPS final score. It can contribute up to 15 points to your MIPS final score (0-100 points).
Performance period. The performance period for cost is the full calendar year (Jan. 1, 2019 to Dec. 31, 2019).
You don’t report or attest anything for cost. CMS uses administrative claims data to evaluate your cost performance.
10 cost measures in 2019. This year, cost measaures include the following:
Only two cost measures are likely to apply to ophthalmologists. As an ophthalmologist, you may be scored on the Total Per Capita Cost measure and the new measure for cataract surgery, but the other seven episode-based cost measures and the Medicare Spending Per Beneficiary measure aren’t likely to apply to you.
Table 15: How CMS Calculates Your Cost Score
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As in 2018, your cost performance category score = cost points scored ÷ cost points available, and it is reported as a percentage.
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Example of how CMS calcualtes your cost score. In this example, you were scored on the Routine Cataract Surgery with IOL Implantation measure and the Total Per Capita Cost measure, but you didn’t meet the case minimum for any other seven episode-based measures or the MSPB measure.
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Measure
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Met Case Minimum?
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Points Scored
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Points Available
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Routine Cataract Surgery with IOL Implantation measure
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Yes
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5 points
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10 points
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Total Per Capita Cost measure
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Yes
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7 points
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10 points
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MSPB measure
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No
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Points total:
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12 points
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20 points
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Cost score (12 /20) = 0.6, which is reported as a percentage: 60%
Cost score is weighted at 15% of your MIPS final score (0-100 points), which means it can contribute up to 15 points.
A cost score of 60% contributes 9 points (60% of 15 points) to your MIPS final score.
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What if you don’t get a cost score? If you don’t meet the case minimum for any cost measures, cost’s contribution to your final score will be reweighted to 0%, and quality’s contribution will be reweighted upward (see Table 5: Reweighting the Performance Categories).
Cost’s Growing Role in MIPS
Cost in 2019. This year, your cost score is weighted at 15% of your MIPS final score (up from 10% in 2018), meaning that it can contribute 0-15 points.
Cost in 2020 and 2021. At time of press, CMS had not yet published its proposed rules for the 2020 performance year. But the agency had earlier indicated that it “anticipates” ramping up cost’s weight in your MIPS final score by 5% and reducing quality’s weight by 5% in 2020 and 2021. Thus, cost would be weighted at 20% in 2020 and 25% in 2021, with quality weighted at 40% in 2020 and 35% in 2021.
Cost in 2022. Starting in 2022, CMS is required by statute to weight cost at 30% of your MIPS final score.
Previous: Improvement Activities at a Glance
Next: Cost: The Routine Cataract Surgery with IOL Implantation Measure
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