This content is excerpted from EyeNet’s MIPS 2022: A Primer and Reference; also see the Academy’s MIPS hub page.
Cost is one of four performance categories that can contribute to your 2022 MIPS final score.
Default weight in MIPS final score: 30%.
This year, the MIPS cost measures include:
Only one or two cost measures are likely to apply to ophthalmologists. As an ophthalmologist, you may be scored on the cataract surgery measure.
Also, some oculofacial specialists may be scored on the Melanoma Resection measure. This episode-based measure evaluates the risk-adjusted cost to Medicare for patients who undergo an excision to remove a cutaneous melanoma. To be scored on this measure, at least 10 episodes must be attributed to you in 2022. (For more on this measure,go to https://qpp.cms.gov, click on “Resources” and then “Resource Library.”)
However, the other 21 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, 2022 to Dec. 31, 2022.
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 one or more other performance categories will be reweighted upward (see “Reweighting the Performance Categories”).
New for 2022: A Cost Improvement Score
Who gets a cost improvement score? CMS only will calculate a cost improvement score for you if you use the same identifier in 2022 as you did in 2021 (see “Use of TINs and NPIs as Identifiers.”)
How CMS calculates your cost improvement score? If you are scored on one or more cost measures in both 2021 and 2022, the number of cost measures with a statistically significant decline in performance is subtracted from the number with a significant improvement. The result is divided by the number of cost measures that were scored for both years. The resulting fraction is multiplied by the “maximum cost improvement score,” which hadn’t been announced at time of press. (When CMS considered introducing this policy for the 2018 performance year, it had proposed a maximum cost improvement score of 1%.)
You can't get a negative score? The minimum cost improvement score is 0%.
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, and adds any cost improvement score. The result is your cost performance category percent score, which contributes up to 30 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%. (If there was a cost improvement score, it would be added to the 60%.) If cost is weighted at 30% of your MIPS final score (0-100 points), a cost score of 60% would contribute 18 points (60% of 30 points) to that score.
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