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MIPS

Cost Performance Category
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Summary of the Cost Category
  • CMS will gather data based on Medicare claims
  • Least administrative burden on clinicians under this category
  • Cost measures are Total per Capita, Medicare Spending per Beneficiary (MSPB) and episode measures
  • Can be reported as an individual or in a group
MIPS Composite performance Score
Understanding Cost

For this category, CMS will independently calculate performance on certain cost measures and a quality measure via claims in order to provide feedback to clinicians in preparation for upcoming performance years.

CMS will calculate measures of total per capita costs for all attributed beneficiaries and a Medicare Spending per Beneficiary (MSPB) measure. It is also in the process of adding 10 episode-based measures that met reliability standards and were previously made available to clinicians in feedback reports.

For 2017, the cost performance category carries no weight in the final score, which will be determined using the other three performance categories.

Cost Category Scoring

As per MACRA’s requirement, the cost performance category contribution to the final score will gradually increase to 30% by performance year 2021.

A MIPS eligible clinician receives one to ten achievement points for each cost measure attributed to the MIPS eligible clinician based on the MIPS eligible clinician's performance compared to the measure benchmark.

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