• MIPS 2018—Cost: The Medicare Spending Per Beneficiary Measure

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

    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 healthpolicy@aao.org.

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    Previous: Cost: The Total Per Capita Cost Measure.

    Next: Cost: Calculating Your Cost Score.

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