Outrunning The MIPS Bear in 2019: Cost, MIPS Wrap-up

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:   

Measure Topic 

Measure Type/Group 

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 in 2019: Improvement Activities Portion

Outrunning The MIPS Bear in 2019

Outrunning the MIPS Bear (Article 1 of 5)

Outrunning The MIPS Bear: Quality Portion (Article 2 of 5)

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)

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Brad Sclar has founded several successful Healthcare IT companies within the last 20 years in the Denver area — PRS Network, Phasis Group, and MD-IT. In addition to multiple IT certifications he supports voice recognition software into multiple EMR environments nationwide, serves as the CIO of the PRS IT Division, overseeing template development, maintenance of client LAN installations, custom software development, HL7 interfaces between EMRs, and the installation of the Health Record portion of the EMR software packages that PRS represents. Currently, he is involved in launching a Urology focused MSO.