This content is excerpted from EyeNet’s MIPS 2021; also see the Academy’s MIPS hub page.
Cost is one of four performance categories that can contribute to your 2021 MIPS final score.
Default weight in MIPS final score: 15%.
This year, the MIPS cost measures include:
- the Total Per Capita Cost (TPCC) measure,
- the Medicare Spending Per Beneficiary measure,
- 18 episode measures, including the Routine Cataract Surgery With Intraocular Lens (IOL) Implantation measure.
Only one cost measures is likely to apply to ophthalmologists. As an ophthalmologist, you may be scored on the cataract surgery measure. However, the other 17 episode-based cost measures don’t apply to ophthalmology; the TPCC measure explicitly excludes ophthalmologists and optometrists; and the Medicare Spending Per Beneficiary measure focuses on inpatient hospitalization costs.
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, 2021 to Dec. 31, 2021.
No reporting requirements. Cost is the only one of the four performance categories where you don’t report data or make attestations. CMS evaluates clinicians’ cost score based on Medicare claims data for patients that it attributes to them.
Won’t apply to all ophthalmologists: You are only likely to be scored on cost if you perform cataract surgery and/ or are in a multispecialty practice that reports as a group. If you are not scored on cost, its weight is reallocated to quality.
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.
- 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.
- 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.
- 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 20% of your MIPS final score (0-100 points), a cost score of 60% would contribute 12 points (60% of 20 points) to that score.
Cost’s Shifting Role in Your MIPS Final Score
During the first five years of MIPS, cost’s weight in your MIPS final score has increased as follows:
- 0% in 2017
- 10% in 2018,
- 15% in 2019 and 2020
- 20% in 2021.
Starting with the 2022 performance year, CMS is slated to weight cost at 30% of your MIPS final score.
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