Quality and Cost are two fundamental focus areas in the Volume to Value-Based Care transition.  The Centers for Medicare & Medicaid Services (CMS), seeks to incentivize higher quality care at a lower cost through programs like MIPS.  In recent years, the primary focus of MIPS has been Quality reporting, however Quality and Cost will be equally weighted in 2022.  Mandated increases and lack of insight into current MIPS scores make it a top priority for practices to learn how Cost impacts their revenue.

What is the MIPS Cost Category?

CMS implemented the MIPS Cost performance category to drive down costs by incentivizing clinicians to focus on total patient care.  Looking at all episodes of care for a given patient will deliver a more complete perspective into patient experience and value of care being delivered.  This is accomplished by assigning a MIPS score to the cost of care for Medicare Beneficiaries including costs that might be incurred outside of a provider’s direct care. 

Cost performance measures are currently weighted at 15% of a clinician’s final MIPS score. CMS calculates scores directly from claims; therefore, no data submission is required.  There are two fundamental measures, Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB), and 18 additional episode-based measures.  CMS added 10 of the episode-based measures in 2020 and intends to keep adding measures so more specialists are included in the Cost category.  Measure eligibility is determined by predetermined minimums for each measure.  

Federally Mandated to be 30% by 2022

In 2022, Cost is mandated to be reweighted to 30%.  This adjustment will result in Cost and Quality having an equally significant impact on a clinician’s Final MIPS score, which may lead you to ask:

• "Am I eligible to be measured on Cost performance?”
• “How does CMS determine my score?”
• “Can I view the data?”
• “Does my organization have enough information to gain insight into Cost performance?”

Clinicians Need Insight

CMS attributes total cost of care for patients through a complex attribution methodology.  If a patient visits their Dermatologist monthly while only visiting their primary care doctor once a year, the Dermatologist may end up getting the total cost of care for the patient attributed to them without realizing it.  Furthermore, the Dermatologist is assigned a score based on costs that they have no access to and won’t know how until 18 months after.  

How are clinicians supposed to improve their Cost score if they do not have insight to the data and methodology they are being scored on?  

When Cost reaches 30% of the final MIPS score, clinicians will need the proper resources to assess how they are performing, enable improvement and achieve success. 

At Healthmonix, we have spent the last year working to solve this problem by becoming a Qualified Entity (QE) with CMS and building our new tool REVlytix™ to view Cost measure performance.  This gives clinicians and administrators faster access via quarterly claims data, rather than the traditional 18  months.  Using REVlytix to analyze recent claims data will equip practices with the tools and information they need to ensure MIPS Cost success.  Head over to the REVlytix info page and contact us today to learn how we can prepare your practice for MIPS Cost success.