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 previous Value-Based Payment Modifier program, which provided incentives to clinicians and groups who provide high quality, low cost care.
The Cost category will apply to all MIPS eligible clinicians and groups, except those participating in a MIPS Alternative Payment Model (APM). Because MIPS APMs, such as the Medicare Shared Savings Program (MSSP), already incentivize clinicians to control costs, the Centers for Medicare and Medicaid Services (CMS) has exempted these clinicians from the Cost category.
Objectives and Measures
In 2018, CMS will measure Cost based on two measures that have been used under the Value-Based Payment Modifier Program:
- Total per capita cost measure for all attributed Medicare beneficiaries
- Medicare spend per beneficiary (MSPB) measure
Clinicians and groups are not required to collect or report data to CMS for the Cost category. CMS will automatically calculate Cost performance based on claims data.
In future years, CMS will also measure cost based on eight clinical episodes attributable to clinicians and groups. The following cardiovascular-related episode groups are currently under review for implementation as early as the 2019 performance period:
- ST-Elevation Myocardial Infarction with Percutaneous Coronary Intervention (STEMI with PCI)
- Elective Outpatient PCI
- Revascularization for Lower Extremity Chronic Critical Limb Ischemia
For the 2018 performance/2020 payment period, Cost will count toward 10 percent of the MIPS composite score for most clinicians. The MACRA statute currently requires that Cost count as 30 percent of the MIPS score starting with the 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 evaluate your highest cost services and/or patients and determine if there are ways to improve your management of these cases.
- Review your 2015 Supplemental Quality and Resource Use Report (sQRUR). The sQRUR includes data on your episode-based performance and can help you understand how you are likely to perform against clinical episode measures.
- 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. Although these do not count toward your 2018 performance year score, they may be used to measure your performance starting as early as 2019.
- Watch for your 2017 Cost data. Review your 2017 Cost data when it becomes available later this year as part of your MIPS feedback. Determine ways to improve the cost of care provided to your patients before the Cost weight increases in future years.