• MIPS 2020—Cost: Total Per Capita Cost Measure

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


    This measure tries to allocate all of a patient’s Medicare Part A and Part B costs to a primary care clinician; but if the pa­tient doesn’t see such a clinician, he or she could be attributed to a non–primary care clinician.

    Academy advocacy pays off. The Academy and other specialty societies have long urged CMS to rethink the unfair way this measure has attributed Medicare costs to specialists. In past years, ophthalmologists have been held responsible for the cost of hernia repair and hospice stays, to give just two examples. Fortunately, the advocacy has paid off, with eye care specialists now being excluded from this measure.

    New for 2020: Ophthalmologists and optometrists are excluded from the TPCC measure. In past years, some oph­thalmologists were scored on the TPCC measure, and some eye care practices decided to bill Eye visit codes rather than Evaluation and Management (E/M) codes in order to avoid meeting the 20-patient case minimum for this measure. In 2020, ophthalmologists and optometrists will be excluded from this measure based on their two-digit specialty iden­tifier in the Provider Enrollment, Chain, and Ownership System, better known as PECOS.

    Caveat. Suppose you are in a multispecialty practice and you have colleagues who aren’t excluded from the TPCC measure. If the practice reports as a group, the group may be scored on this measure.

    What if you aren’t excluded? If the above caveat doesn’t apply to you but you are still scored on this measure, please contact the Academy at healthpolicy@aao.org.

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