What Is the MIPS Cost Category?

mips cost category

In our ongoing series about MACRA and what to expect in 2017, there’s one more category of MIPS that we want to cover: the Cost (or Resource Use) category. Read on to learn more about the MIPS cost category and what it will mean for practitioners.

The MIPS Cost Category: What It Is

When CMS determines cost administratively, it does so by analyzing claims. This means that the provider doesn’t actually have to do anything. Patients are designated to certain providers by means of an attribution process based on who is providing the plurality of care.

To account for differences among specialties, CMS intends to use 40 episode-specific measures – and the method in which patients are attributed is, once again, critical.

Carryover from the VM Program

Two measures from the VM program will be carried over by MACRA. They are:

  •      Total costs per capita for all attributed beneficiaries
  •      Medicare spending per beneficiaries

CMS plans to take the scores of all resource use measures for MIPS-eligible practitioners and average them. In the event that a clinician doesn’t have enough patient volume for any cost measures, then no score will be calculated.

Regarding anesthesia providers, they might not have any attributed beneficiaries to calculate cost. CMS is still working on a way to re-weight the other categories in order to make up for this, and once the final rule is in place, we should know what to expect.

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