And on to the final category, Cost (15% overall scoring weight) which covers the total cost of patient care throughout the 2019 year, both out-patient and hospital events. Cost measures are evaluated automatically through administrative claims data, so there is no data submission requirement: ain’t that grand!
But there are significant changes in the Cost category this year, and we may as well dive in and start wrapping our brains around it… turns out there were 10 Cost Measures, and CMS was using only the first two for 2017 and 2018: 1) Medicare Spending per Beneficiary (MSPB) and 2) Total Per Capita Costs (TPCC).
Now they’re adding the rest of the eight episode-based cost measures to the equation:
|Routine Cataract Removal with Intraocular Lens (IOL) Implantation Measure||Procedural|
|Intracranial Hemorrhage or Cerebral Infarction Measure||Procedural|
|Knee Arthroplasty Measure||Procedural|
|Elective Outpatient Percutaneous Coronary Intervention (PCI) Measure||Procedural|
|Simple Pneumonia with Hospitalization Measure||Procedural|
|Lower Extremity Chronic Critical Limb Ischemia Measure||Acute inpatient medical condition|
|Screening/Surveillance Colonoscopy Measure||Acute inpatient medical condition|
|ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI) Measure||Acute inpatient medical condition|
The Measures are further delineated into Episode Groupings that:
a) Represent a clinically cohesive set of medical services rendered to treat a given medical condition, and
b) Aggregate all items and services provided for a defined patient cohort to assess the total cost of care. (A ‘patient cohort’ is a grouping of patients with similar medical conditions).
Well, ok then! And I could dig into it more (there’s fact sheets and never-ending info on the CMS website), but you get the idea, right? CMS is looking to track Cost: “Measuring cost is an integral part of measuring value” is how they put it… in other words, if you’re billing out a significant number on any of the 8 measures listed above, be aware, CMS is looking.
And so, my friends, we come to the end of each MIPs item, here at the end of the race: Da Bear has been outrun for 2019. As you consider the 4 categories: 1) Quality, which used to be PQRS and 2) Promoting Interoperability (PI), which used to be MU, then morphed into ACI and 3) Improvement Activities (IA), which is new and finally 4) Cost the big question is:
Do you have your staff on board? Workflow items accounted for, documentation pieces firmly understood, reports produced and saved that demonstrate MIPS success in the event of an audit?
That’s the key: actually doing the 3 MIPs categories in your EMR and being able to prove you did! Like one of my favorite people, Arnold Schwarzenegger, says: why do it if you can’t show it? If you can’t prove you outran Da MIPs Bear, why run?
Contact us if you need help!
Other MIPS Articles
Outrunning The MIPS Bear: Promoting Interoperability Category (Article 3 of 5)
Outrunning The MIPS Bear: Improvement Activities Portion (Article 4 of 5)
Outrunning The MIPS Bear: Cost Portion (Article 5 of 5)