• MIPS 2018—Overview 4: The Cost Performance Category

    Written By: Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS

    This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page

    No reporting necessary. CMS will review administrative claims data and attempt to score you on 2 measures. The performance period is the full calendar year.

    The Total Per Capita Cost measure. If a patient is seen for any office visit during 2018, CMS will attempt to determine if they were seen for primary care services and assign all that patient’s Medicare Part A and Part B costs to the primary care clinician.

    A 2-step attribution process. First CMS attempts to assign a patient’s costs to the primary care physician or supporting clinician (e.g., a nurse practitioner) who provided the patient with the most primary care services during 2018. If it can’t do that, CMS assigns the patient’s costs to the physician who provided the most office visits for the patient.

    The Medicare Spending Per Beneficiary (MSPB) measure. The MSPB measure focuses on hospital admissions. It defines an episode of care as starting 3 days before the admission and ending 30 days after the patient is discharged.

    Attribution. All Medicare Part A and Part B costs that were incurred during a patient’s episode of care are assigned to the clinician who provided the most Medicare part B costs. Very few ophthalmologists will fall under this measure.


    You will only be scored on a measure if you meet the case minimum. The Total Per Capita Cost and MSPB measures have case minimums of 20 patients and 35 episodes of care, respectively. If you don’t meet the case minimum for both measures, cost’s contribution to your MIPS final score will be reweighted to zero and quality’s contribution reweighted upward (see Table 3: Reweighing the Performance Categories).

    CMS attempts to level the playing field. CMS will, for example, exclude extreme outliers and make risk adjustments. However, the Academy believes that these adjustments are inadequate and the measures are substantively flawed.

    Score 1-10 points for each measure. Your score will depend on how your performance compares against the national average for 2018.

    CMS calculates your cost score (1%-100%). Your points total is divided by either 10 or 20 (depending on whether you met the case minimum for 1 or 2 measures) and the resulting fraction is turned into a percentage. This is your cost score.

    Cost score contributes up to 10 points to your MIPS final score. For example, if your cost score is 50%, it contributes 5 points.

    For a deeper dive into the cost performance category, see Cost’s Role in MIPS.


    Previous: Overview 3: The Improvement Activities Performance Category.

    Next: Table 4: MIPS Timeline for 2018

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