The Cost category of the Merit-Based Incentive Payment System (MIPS) assesses clinicians and groups based on the cost of care provided to Medicare beneficiaries. The Cost category is built upon elements of the Value-Based Payment Modifier program, which provides incentives to clinicians who provide quality care to patients while lowering cost. For the 2017 performance/2019 payment period, Cost will not be factored into the MIPS composite score. The Centers for Medicare and Medicaid Services (CMS) will gradually phase Cost into the MIPS score in future performance years.
All MIPS eligible clinicians and group practices will receive feedback on their Cost category performance in 2017, but it will not count toward their MIPS score. Cost data will be calculated using Medicare claims data. No additional reporting is required by clinicians or groups.
Objectives and Measures
The Centers for Medicare and Medicaid Services (CMS) will measure Cost based on:
- Total per capita cost measure for all attributed Medicare beneficiaries
- Medicare spend per beneficiary (MSPB) measure
Both of these measures are used under the 2017 Value-Based Payment Modifier program. CMS will also measure cost based on clinical episodes attributable to clinicians and groups. The following cardiovascular-related episode groups are among the 10 episodes finalized for the 2017 performance year:
- Aortic/Mitral Valve Surgery
- Coronary Artery Bypass Graft (CABG)
- CMS is testing additional episode groups for implementation in future years of the MIPS program.
For the 2017 performance period/2019 payment period, Cost will account for zero percent of a clinician’s or group’s MIPS composite score. While Cost will not be included in the first year of MIPS scores, clinicians and groups will receive data on their participation against the cost measures for informational use only.
Cost performance will gradually be incorporated into the MIPS score starting in either the 2018 or 2019 performance period.
Quick Tips to Prepare for Cost Assessment
- Review your 2016 Annual Quality and Resource Use Report (Annual QRUR). The Annual QRUR provides information on your cost and quality performance under the 2018 Value-Based Payment modifier. If you are a "high cost" clinician or group, you may want to determine where your highest costs are.
- Review draft episode group cost measures in development for future MIPS performance years, particularly those designed for Elective Outpatient PCI, STEMI with PCI and Revascularization for Lower Extremity Chronic Critical Limb Ischemia.
- Use the 2017 Cost data, even if you are not being scored on it. Review your 2017 Cost data when it becomes available and determine if you need to make any changes to your practice before Cost is factored into the MIPS score in future years.