For the 2023 performance year, eligible clinicians and groups may receive a Cost performance category score that accounts for 30% of their final MIPS score. ECs and groups do not need to submit data or attest to anything for this category. Instead, CMS uses claims data to assess an individual or group's performance during the performance year.
In 2023, CMS will use claims data to assess individual ECs and their groups on the cost measures below. Attribution of individual ECs or groups to these measures is often dependent upon the plurality of services and costs provided to individual patients for these measures. If an EC or group is unable to be scored in the Cost category, the 30% weighting will be redistributed to the Quality performance category (unless you are in a small group).
Facility-based measurement scoring will be used for your quality and cost performance category scores when all the following conditions are met: 1.) You're identified as facility-based; and 2.) You're attributed to a facility with a FY 2024 Hospital Value-Based Purchasing (VBP) Program score. The MIPS quality and cost performance category scores will be based on the facility-based measurement scoring methodology unless a clinician or group receives a higher MIPS final score through another MIPS submission.
Because of the COVID-19 pandemic, CMS decided not to calculate certain hospital total performance scores for the Hospital Value-Based Purchasing (VBP) Program. This action resulted in facility-based scoring not being available for MIPS participants in 2021 and 2022. At this time, CMS has not announced whether facility-based scoring will be available for MIPS participants in 2023. If it is available, CMS will use the total performance score from the Hospital VBP Program to calculate MIPS facility-based scores for facility-based clinicians and groups in the quality and cost performance categories.
Beginning in the 2023 performance period/2025 MIPS payment year, a facility-based MIPS eligible clinician is eligible to receive the complex patient bonus, even if they do not submit data for at least one MIPS performance category. CMS notes that all MIPS eligible clinicians will receive a cost improvement score of zero percentage points for the 2022 performance period because CMS did not calculate cost measure scores for the 2021 performance period.
Population-based cost measures:
Medicare spending per beneficiary (MSPB)
Total per capita cost (TPCC)
Procedural episode-based cost measures:
Elective outpatient percutaneous coronary intervention (PCI)
Revascularization for lower extremity chronic critical limb ischemia
Routine cataract removal with intraocular lens (IOL) implantation
Acute Kidney Injury Requiring New Inpatient Dialysis
Elective Primary Hip Arthroplasty
Femoral or Inguinal Hernia Repair
Hemodialysis Access Creation
Lumbar Spine Fusion for Degenerative Disease, 1-3 levels
Lumpectomy, Partial Mastectomy, Simple Mastectomy
Non-Emergent Coronary Artery Bypass Graft (CABG)
Renal or Ureteral Stone Surgical Treatment
Colon and Rectal Resection
Acute inpatient medical condition episode-based cost measures:
Intracranial hemorrhage or cerebral infarction (Acute inpatient medical condition)
Simple pneumonia with hospitalization (Acute inpatient medical condition)
ST-Elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI) (Acute inpatient medical condition)
Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation
Lower Gastrointestinal Hemorrhage (at group level only)
Chronic condition episode-based cost measures:
Asthma/Chronic Obstructive Pulmonary Disease (COPD)
Cost measure specifications and regulatory information are available on the Quality Payment Program website. ASA continues to advocate for physician anesthesiologists to be fairly and accurately assessed under the MIPS cost category.