This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page.
The Medicare Spending Per Beneficiary (MSPB) measure focuses on costs associated with hospital admission. CMS has stated that very few ophthalmologists are likely to meet this measure’s 35-episode case minimum.
What is an MSPB episode of care? An MSPB episode of care starts 3 days before a patient is admitted to hospital and ends 30 days after he or she is discharged.
What costs are included? All Medicare Part A and Part B charges.
Which episodes of care are attributed to you? An episode of care—along with its associated costs—is attributed to you if you provided the most Medicare Part B covered services during the hospitalization, even if the hospital admission is unrelated to ophthalmology.
As with the Total Per Capita Cost measure, CMS attempts to account for some factors that might unfairly skew how this measure is scored.
There is a 35-episode case minimum. In order to get a score for this measure, at least 35 episodes of care must be attributed to you.
You score 1-10 points. As with the Total Per Capita Cost measure, your score will depend on how your performance compares with other MIPS participants during the current performance year.
A problematic measure. Given the prevalence of chronic eye conditions in the Medicare population, potentially many MSPB episodes of care could be unfairly attributed to ophthalmologists.
If you are scored on this measure, please contact the Academy at email@example.com.
Previous: Cost: The Total Per Capita Cost Measure.
Next: Cost: Calculating Your Cost Score.
Note: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.
COPYRIGHT© 2018, American Academy of Ophthalmology, Inc.® All rights reserved. No part of this publication may be reproduced without written permission from the publisher. American Academy of Ophthalmic Executives® and IRIS® Registry are trademarks of the American Academy of Ophthalmology®.