2019 MIPS Cost FAQs 


What is the Cost Performance Category?

This performance category was created by CMS for MIPS to support broad aims within healthcare including care coordination, beneficiary engagement, population management and health equity. Clinicians are rewarded for activities that improve clinical practice, such as shared decision-making and increasing access. The Cost category evaluates the resources Medicare providers use to care for patients and the payments for medical services provided during a performance period. It incorporates the Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC) measures from the legacy Value Modifier program, which MIPS replaced. Detailed information about these two measures is available in the 2018 MSPB Measure Information Form and the 2018 TPCC Measure Information Form.

Additional information about MIPS reporting is available in the 2019 MIPS Executive Summary.

CMS finalized the Cost category weight at 15% for all eligible clinicians participating in MIPS in 2019. This increase from Year 2 of the MIPS program was required by the Bipartisan Budget Act of 2018.

For Year 3 of the MIPS program, the MSPB and TPCC measures will be used in the Cost category along with eight new episode-based measures:


Am I required to participate and report for the MIPS Cost Category?

CMS abstracts from Medicare Parts A and B fee-for-service administrative claims, so MIPS-eligible clinicians do not have to perform any additional data collection or reporting.

Anesthesia services are included in the costs evaluated by the measures, but they only represent a small portion of those costs. Therefore, CRNAs and other anesthesia providers could be included in measure scoring especially if they belonged to a multi-specialty practice that included clinicians that provided the services that trigger applicable Cost Measures.

What services and payments are evaluated by MIPS Cost measures?

The MSPB measure evaluates services related to chronic disease management, using data from Medicare Part A and B claims. It calculates the ratio of observed MSPB episode costs to the expected costs, divided by the total number of MSPB episodes attributed to an eligible clinician's (EC) TIN-NPI. The likelihood that a CRNA or other anesthesia providers and group practices are attributed this measure is low.

The TPCC measure looks at costs associated with primary care inpatient and outpatient services provided to a Medicare beneficiary during the performance year. It calculates the cost of care provided to beneficiaries by an individual EC or group, divided by the number of beneficiaries attributed to the provider or group. Like the MSPB measure, the likelihood of an anesthesia provider or group practice being attributed this measure is low.

Episode-based Cost Measures evaluate the cost of items and services clinically related to the episode of care for the specified clinical conditions or procedures. Assigned services can include anesthesia, which are included in the costs, but they do not trigger evaluation of the measures.

How is the Cost Performance Category scored?

Clinicians can earn from 1 to 10 achievable pints for each applicable Cost measure reported for solo practitioners or groups at the TIN or NPI level. For clinicians reporting as a group, a single measure score is calculated and assigned to the group. The Cost category performance scores are compared to a single, national benchmark based on data from the performance period. Performance feedback for 2019 Cost Measure data will be available during the summer of 2020.

How are Cost Measures attributed?

The MPSB measures are attributed to the providers that rendered the most physicians and supplier services for chronic disease management during the period between the hospital admission date and discharge date, during the performance period. Attribution for the TPCC measure is determined by the clinician that provided more allowed charges for primary care services than any other TIN-NPI during the performance period.

Acute inpatient medical condition episode-based measures are attributed to the MIPS EC who bills the majority of Medicare Part B claims for the admission. Procedural episode measures are attributed to each MIPS EC who renders a triggering service by HCPCS/CPT codes. CRNAs don't usually bill the majority of Medicare Part B claims or provide services that trigger HCPCS/CPT codes used in the measures.

Are Cost Measures risk adjusted?

Cost Measures are risk-adjusted to account for patient characteristics and clinical risk that are beyond the provider's control and can impact spending on services. The methodology used for Cost Measure in the performance category is different. Details about the risk adjustment methodology for 2019 Cost Measures is included in the Measure Information Forms.

The episode-based measures use risk adjustors for the CMS Hierarchical Condition Categories (HCC). They are identified using beneficiaries' Medicare claims history from the period before the episode of care.

How does performance in the Cost Category affect my overall MIPS score?

Cost measures are weighted at 15% of the total MIPS score. If no Cost measures are applicable to an individual provider or group, then the category is re-weighted to the Quality performance category.

What is the reporting period for the Cost category?

The performance period for Cost measures is an entire calendar year. For Year 3 that period is from January 1, 2019 through December 31, 2019.

Where can I get additional information about Cost Measures?

CRNAs can contact the Quality Payment Program by calling 1-866-288-8292 (TTY 1-877-715-6222), Monday through Friday from 8:00am to 8:00pm EST, or e-mail: QPP@cms.hhs.gov. The QPP Resource Library contains the Cost Performance Fact Sheet and Measure Information Forms. Technical assistance is also available through the QPP Website.