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MIPS - Cost

MIPS - Cost
Posted: April 2, 2018

Cost is the fourth and final performance category in the Merit-based Incentive Payment System in 2019 and accounts for 15% of the Final Score.  Ten measures are used to measure performance:  two that have been around from the start of the program in 2017:

  • Total Per Capita Cost (TCPP)
    • measures all Part A and B costs for attributed beneficiaries during the year
  • Medicare Spending Per Beneficiary (MSPB)
    • measures what Medicare pays for services during an “episode”.  Episodes are defined as the period immediately before, during, and after a patient’s hospital stay.

And 8 new “episode-based” measures.  These differ from the measures above in that episode-based measures include only items and services related to an episode of care for a specific condition or procedure.

CMS uses Medicare claims data to calculate each of the 10 measures.  Thus, clinicians do not need to track or submit any additional data for this performance category.

Cost measures are risk-adjusted to account for differences at the patient level that can impact outcomes and costs, irrespective of the quality of care provided.

While it’s important to know that these measures are collected and potentially impact a clinician’s MIPS final score, good performance in the Cost category boils down to providing exactly the care that clinicians feel their patients need, no more and no less.

In the event that the minimum case volume isn’t achieved for either broad measure (20 for TPCC and 35 for MSPB) or any of the episode-based measures (10 for Procedural measures and 20 for Acute Inpatient Medical Condition) a Cost performance category score would not be possible.   In these instances, the clinician will see the 15% contribution of the category shift to the Quality performance category.


Reporting for the Cost category will be simple as no data submission is required.  Instead, Medicare will aggregate any and all required information from claims that clinicians submit for services rendered.






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Updates Prior to 2018