2019 MIPS

Cost Performance Category

  • 10 measures, including 2 overall primary care measures and 8 new episode-based measures, are automatically captured through claims data.
  • Total Category Score is averaged from the score of all applicable measures.
  • Measure performance is tracked over a full calendar year.
  • Clinicians can preview 2018 performance in July of 2019, and 2019 performance in Summer of 2020. MIPSPRO Enterprise members are able to receive this information quarterly.
15 %
of MIPS Composite Performance Score


Key Changes From 2018 Cost Reporting

  • In 2018, Cost comprised 10% of the MIPS Performance Score and Quality comprised 50%. For 2019, the final score weighting has been adjusted so that Cost has a 15% weight and Quality has a 45% weight.
  • Eight episode-based measures will now be a part of the Cost performance category score.

Cost Final Score

To calculate Cost, CMS will assign 1 to 10 achievement points to each scored measure shown in the table below, based on the clinician or group’s performance compared to the performance year benchmark. Therefore, achievement points for each measure depend on which decile range you or your group’s performance falls in.

The maximum score for the category is 100%. Additional bonus points will not be applied to a perfect achievement score.

Measure Topic

Measure Type

Minimum Case Volume

Medicare Spending Per Beneficiary (MSPB)

n/a

35

Total per Capita Cost

n/a

20

Elective Outpatient Percutaneous Coronary Intervention (PCI)

Procedural

10

Knee Arthroplasty

Procedural

10

Revascularization for Lower Extremity Chronic Critical Limb Ischemia

Procedural

10

Routine Cataract Removal with Intraocular Lens (IOL) Implantation

Procedural

10

Screening/Surveillance Colonoscopy

Procedural

10

Intracranial Hemorrhage or Cerebral Infarction

Acute Inpatient Medical Condition

20

Simple Pneumonia with Hospitalization

Acute Inpatient Medical Condition

20

ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)

Acute Inpatient Medical Condition

20


CostPRO 2019

CostPRO 2019 Tracking software is the next big thing in Cost performance tracking and optimization.

 

Drill into

your data.

Look at data by quarter or across multiple quarters. Compare by TIN, by measure, or compare data from past years with current measures. Our tracking software lets you view your data from any angle so that you have the full story.

Integrate to

match your needs.

With our adaptable solutions, you can choose to track Cost separately--or link that data to your MIPSPRO account so you can view your big picture from one secure, user-friendly dashboard.

Optimize your score

and your practice.

CostPRO 2019 helps you understand how much and where to spend on each patient, empowering you to optimize your business decisions based on CMS policy and best practices.

Reach out today to learn what CostPRO 2019 can do for your bottom line.


New Course: Introduction to MIPS Cost

Stay up to date with the latest news regarding MACRA and MIPS.

The Healthmonix Advisor is a free weekly news source, connecting you to the latest updates in the value-based care industry.