About the MIPS Cost Performance Category 

The cost performance category is one of four performance categories that make up a clinician’s final MIPS score. This category, which measures Medicare payments made for care provided to patients, makes up 30% of the final score. 

While clinicians do not set the price of individual services, they do affect the frequency of services rendered and which types are provided. With improved care coordination and services management, clinicians can improve health outcomes, ensuring their patients receive the right services at the right times. To do this, organizations need to understand cost category measures. 

The first measure is Medicare Spending Per Beneficiary (MSPB). MSPB assesses the cost of services related to a qualifying inpatient stay. The attribution method categorizes inpatient stays as either a surgical or medical episode. These episodes are identified as starting 3 days before admission to 30 days after discharge. The measure evaluates a hospital’s efficiency by comparing the cost of care during episodes to the median cost nationwide. The case minimum for this measure is 35 episodes. 

The next measure is Total Per Capita Cost (TPCC). This measure assesses the cost of care delivered to a Medicare patient with a focus on primary care. The measure calculates the total costs for each of a clinician’s beneficiaries over the clinicians’ total Attributable Beneficiary Months. These are months where a beneficiary’s risk window and the performance year overlap. The case minimum for this measure is 20 Medicare patients. 

In addition, the cost category also includes 15 procedural episode-based measures, which assess the cost of care as related to a specific procedure or treatment administered during the episode time frame. There are 6 acute inpatient medical condition episode-based measures and 2 chronic condition episode-based measures. The 6 inpatient measures assess cost of care for specific acute conditions during an episode time frame, while the chronic condition measure assesses cost of care related to management of the patients’ condition. The measures evaluate a total attribution window divided into episodes. 

HCIS can help you get started today.  

While this information may seem complex, know that the team at HCIS can help you understand all the complexities of the MIPS program. We have helped thousands of providers avoid penalties and receive positive payment adjustments.  

Contact us today to learn more and be sure to sign up for our upcoming webinars to learn more about MIPS reporting and the other HCIS offerings available to your organization.