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MIPS - Cost Performance

The Cost Performance category, which replaced the physician value-based modifier, is worth 10% of the total MIPS score in 2018. The weight will be 10-30% in 2019-2021.

You do not need to report on these measures – Medicare will calculate your costs based on claims submitted. Cost performance will be based on Total per Capita Cost (TPCC) (which assesses all Medicare Part A and B costs for each beneficiary attributed to you) and Medicare Spending per Beneficiary (MSPB) (which assesses Medicare Part A and B costs incurred from 3 days prior through 30 days post discharge from an inpatient admission).   

CMS will compare your expected costs compared actual.  Therefore, it is important to understand risk adjusted coding, also known as Hierarchical Condition Coding, so that you can ensure you are getting the proper risk adjustment for your patients.

CMS will provide feedback on episode-based measures, but will not count toward your Cost score in 2018.

Below is a summary of the requirements for this category:

Policy 2018 (Year 2)
Measures Used MSPB and total per capita cost, but NOT the episode-based measures
Reporting/Scoring No change
Performance Period Full Year

10% in 2018

10-30% in 2019-2012

  • Risk adjustment will be based on HCC scores
  • Bonus points if you improved your score (if you submitted a full set of data)

CMS will provide initial feedback using the QPP performance feedback report (formerly known as the Quality Reporting and Utilization Report, or QRUR). Participants are encouraged to review their feedback reports when they become available (expected in summer of 2018).