This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page.
The cost performance category contributes up to 10 points to your MIPS final score (0-100 points). It is 1 of 4 performance categories that contribute to that score, and it is the only one where you don’t have to do any reporting or attesting. Instead, CMS uses administrative claims data to evaluate your performance. The performance period is the full calendar year.
Cost’s Role in MIPS Is Slated to Grow
Cost in 2017. For the 2017 performance year, CMS assigned you a cost score but did not factor it into your MIPS final score.
Cost in 2018. In 2018, your cost score is weighted at 10% of your MIPS final score (0-100 points). In other words, it can contribute up to 10 points to that final score.
Cost during 2019-2021. Over the next 3 years, CMS can decide on a year-by-year basis how much weight to give the cost performance category when calculating MIPS final scores. However, this flexibility is limited as follows:
- At minimum, cost’s contribution to the final score would be weighted at 10%, with quality weighted at 50%, advancing care information (ACI) weighted at 25%, and improvement activities weighted at 15%.
- At most, cost’s contribution to the final score would be weighted at 30%, with quality weighted at 30%, advancing care information (ACI) weighted at 25%, and improvement activities weighted at 15%.
Cost in 2022. Starting in 2022, cost’s contribution to your final score will be weighted at 30%.
In 2018, Cost Has 2 Measures
Your 2018 cost score will be based on up to 2 measures:
Both of these flawed measures were carried over from the Value-Based Modifier program, with some changes to their attribution methods.
Episode-based measures are expected to return in 2019. In the past, CMS had used a third type of measure for evaluating resource use: episode-based measures. Although such measures aren’t currently in use, CMS is developing new episode-based measures—including a measure for routine cataract surgery—that it plans to incorporate into MIPS in 2019.
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Next: Cost: The Total Per Capita Cost Measure.
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