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  • MIPS 2020—Cost: An Overview

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    This content is excerpted from EyeNet’s MIPS 2020; also see the Academy’s MIPS hub page.

    Cost is one of four performance categories that can contribute to your 2020 MIPS final score.

    Default weight in MIPS final score: 15%.

    Twenty cost measures in 2020, but only one is likely to apply to ophthalmologists: This year, the MIPS cost measures include:

    Performance period is the full calendar year. When CMS evaluates you on cost, they will include the cost of items and services that were provided from Jan. 1, 2020 to Dec. 31, 2020.

    No reporting requirements: CMS evaluates clinicians’ cost score based on Medicare claims data for patients that it attributes to them.

    What if you don’t get a cost score? If you don’t meet the case minimum for the cataract surgery measure, and assum­ing you aren’t scored on any of the other cost measures, cost’s contribution to your final score will be reweighted to 0%, and quality’s contribution will be reweighted upward (see “Table: Performance Category Weights”).

    How CMS Calculates Your Cost Score

    This can be described as a three-step process.

    1. Your achievement point total is your numerator. For each cost measure you are scored on, you will receive 1 to 10 achievement points based on how your performance compares to the measure’s benchmark.
    2. The number of points available to you is your denomi­nator. If you are only scored on the cataract surgery measure, then your denominator would be 10. 
    3. CMS does the math. After dividing the numerator by the denominator, CMS turns the result into a percentage, which is your cost performance category percent score. This contributes up to 15 points to your MIPS final score.

    Example. After the performance year is over, CMS deter­mines that a clinician only met the case minimum for the cataract surgery cost measure.

    Suppose the clinician scores 6.0 achievement points for that measure. Her numerator is 6.0 and, because she was only scored on one cost measure, her denominator is 10.

    So her cost score is 6.0 ÷ 10 = 0.60, which is reported as a percentage: 60%. 

    Since cost is weight­ed at 15% of your MIPS final score (0-100 points), a cost score of 60% would contribute 9 points (60% of 15 points) to that score.

    MIPS Tip: What You Can Do

    Do you perform cataract surgery? If you—or, if reporting as a group, anybody in your practice—performs cataract surgery, familiarize yourself with the Routine Cataract Surgery With IOL Implantation measure (visit the Academy’s MIPS hub page and click on the cost page, where you can download a CMS PDF on the measure).

    Review your past performance. If you were scored on any cost measures during the 2019 performance year, CMS will send you some detailed feedback this summer and has said that it aims to get this to you by July.

    Cost’s Shifting Role in Your MIPS Final Score

    During the first four years of MIPS, cost’s weight in your MIPS final score increased from 0% in 2017 to 10% in 2018 and then 15% in 2019 and 2020.

    Future weight? At time of press, CMS had not yet an­nounced cost’s weight for 2021. By 2022, CMS is required by statute to weight cost at 30% of your MIPS final score.

    Previous: Table: Improvement Activities at a Glance

    Next: Routine Cataract Surgery With IOL Implantation 

    DISCLAIMER AND LIMITATION OF LIABILITY: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.

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    All of the American Academy of Ophthalmology (AAO)–developed quality measures are copyrighted by the AAO’s H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care (see terms of use).