• MIPS Cost—What’s New for 2019

    Written By: Chris McDonagh, Cherie McNett, and Jessica Peterson, MD, MPH

    Excerpted from “MIPS—What’s New for 2019”, a two-part EyeNet series (January and February, 2019). You also should bookmark EyeNet's MIPS 2019 (published online ahead of print) and the Academy's MIPS hub page.


    New cataract measure. In 2019, CMS will start scoring ophthalmologists on a new episode-based measure: Routine Cataract Surgery With Intraocular Lens (IOL) Implantation (0-10 points).

    • Attribution. An episode of cataract surgery will be attributed to the clinician who performed the procedure, as identified by HCPCS codes or CPT codes.
    • Case minimum. This cataract measure has a case minimum of 10 episodes, which means that it only will contribute to your cost score if at least 10 episodes of cataract surgery are attributed to you.
    • What costs are included? The measure takes into account only the cost of items and services that are related to the cataract procedure (unlike the Total Per Capita Cost measure, which includes all services provided to a patient over a given time frame). Your costs for the measure will undergo payment standardization and risk adjustment, in an attempt to account for cost variations that are beyond your control, such as geographic variations in wage levels and patient characteristics that might lead to increased spending.

    Other cost measures. As in 2018, you only get a score for the Total Per Capita Cost measure (0-10 points) if at least 20 patients are attributed to you. Patients are attributed to you if they were not seen by a primary care clinician and you billed the majority of their primary care services, which can include evaluation and management (E&M) services but not Eye visit codes.

    There also is a Medicare Spending Per Beneficiary measure (MSPB; 0-10 points), but it is an in-patient measure and should not be applied to ophthalmologists.

    Calculating your cost performance category score. Like last year, your cost performance category score = cost achievement points ÷ available cost points, and is reported as a percentage.

    Example. Suppose CMS scored you as follows:

    • 5 points for the Total Per Capita Cost measure (out of 10 available points);
    • 7 points for the cataract episode-based measure (out of 10 available points)

    Your cost achievement points would be 12 (5 + 7) and your available cost points would be 20 (because you were only scored on two cost measures).

    So your cost score, would be cost achievement points (12) ÷ available points (20) = 0.6, or 60%.

    Cost can contribute up to 15 points to your 2019 MIPS final score; a cost score of 60% would therefore contribute 9 points (60% of 15 points) to your MIPS final score.

    Previous: MIPS Improvement Activities—What’s New for 2019

    Next: Review the EyeNet's MIPS 2019: A Primer and Reference (published online ahead of print) .

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