• MIPS 2020—Cost: Routine Cataract Surgery With IOL Implantation Measure

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


    The Routine Cataract Surgery with IOL Implantation mea­sure doesn’t involve any additional reporting on your part. Instead, CMS will use Medicare claims data to 1) attribute routine cataract surgeries to you and 2) track costs that are clinically associated with those surgeries.

    Which surgeries are attributed to you? An episode of rou­tine cataract surgery will be attributed to the MIPS eligible clinician who performed the procedure that “triggers” the episode. That procedure is known as the “trigger service” and the date it took place is the “trigger day.”

    If you bill CPT code 66984—which is the code for routine cataract surgery—an episode of cataract surgery will be attributed to you unless an exclusion applies.

    Exclusions include significant ocular conditions, such as a retinal detachment, that might impact the outcome of the surgery. CMS reviews the patient’s Medi­care claims history to see if there were any ICD-10 diagnosis codes that would flag such an exclusion.

    (Note: Under this measure, billing CPT code 66982 for complex cataract sur­gery would not trigger an episode.)

    A 10-episode case minimum. The cataract measure will only contribute to your cost score if at least 10 episodes of routine cataract surgery are attributed to you in 2020.

    What costs are included? The measure takes into account only the cost of services that are clinically related to the cata­ract surgery. CMS identifies those costs by reviewing the patient’s Medicare claims over a five-month period. This review period starts 60 days before the day of surgery (the trigger day) and ends 90 days after surgery (mirroring the familiar 90-day postoperative period).

    CMS tries to level the playing field. Your costs for the measure will undergo payment standardization and risk ad­justment. This is intended to account for cost variations that are beyond your control, such as patient characteristics that may lead to increased spending and geographic variations in wage levels.

    Furthermore, CMS recognizes that costs might vary depending on whether surgery was done in an ambulatory surgery center (ASC) or a hospital outpatient department (HOPD), and that costs also can vary depending on whether the cataract surgery is unilateral or bilateral (which it defines as the second surgery being done within 30 days of the first). Consequently, CMS divides episodes of routine cataract sur­gery into four subgroups and will only compare an episode’s costs against the cost of episodes within the same subgroup. The four subgroups for routine cataract surgery are:

    • unilateral surgery in an ASC,
    • bilateral surgery in an ASC,
    • unilateral surgery in a HOPD, and
    • bilateral surgery in a HOPD.

    (Note: The 10-episode case minimum requirement applies to measure as a whole, not to the indi­vidual subgroups.)

    You score 1-10 points. You can get a score from each of the four cost subgroups, and a weighted average will be used to calculate your score for the cataract measure. Each sub­group score will be based on how your performance compares with that of other MIPS participants in that subgroup during the current performance year.

    Learn more about the cataract measure. To learn how the new measure was developed, read an overview by David Glasser, MD, (Ophthalmology. 2019;126(2):189-191). You also can download a detailed measure information form by CMS: Go to the Academy MIPS hub page, click on the cost page, and then scroll down to “What You Can Do.”

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    Next: Cost: Total Per Capita Cost Measure 

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