American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Reporting for Cost

Cost 15%

The Cost component is worth 15 percent of the Merit-based Incentive Payment System (MIPS) final score in 2019, a 5 percent increase from previous years. The Centers for Medicare and Medicaid Services (CMS) will calculate cost for the 2019 performance period using data from claims. This means that although Cost will be a weighted performance category in 2019, surgeons will not need to take any action with respect to reporting for cost. In other words, THERE ARE NO REPORTING REQUIREMENTS FOR COST.

CMS will base the cost score on two measures: The Total Per Capita Costs (TPCC) for all attributed Medicare Beneficiaries measure and the Medicare Spending per Beneficiary (MSPB) measure. In addition to the TPCC and MSPB measures, beginning with the 2019 performance year, CMS will also use 8 episode-based cost measures to determine a clinician’s cost score; these will only be used if the designated episodes are applicable to their practice.

With the increase in the MIPS performance threshold in 2019, the Cost category could be helpful in avoiding a penalty. CMS intends to provide feedback on 2018 cost measure performance data by the summer of 2019, in order for physicians to better understand their cost score. As the cost category weight and overall MIPS performance threshold continues to increase, it becomes increasingly important to understand your previous performance in this category. We recommend becoming familiar with your 2017 and 2018 feedback reports, as they will be good tools to assist in estimating possible scores for cost in 2019.

Additional information about each specific 2019 Cost measure is available on the CMS QPP website. CMS also offers a Cost Category fact sheet, which provides more details about the methodology for attributing and scoring these measures.

CMS also offers many resources on their Quality Payment Program website, and is a great resource for learning about and selecting Quality measures, Promoting Interoperability measures, and Improvement Activities for reporting in 2019.