MIPS Cost Performance Category

For the 2021 performance year, eligible clinicians and groups will receive a Cost performance category score that accounts for 20% 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.

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 2022 Hospital Value-Based Purchasing (VBP) Program score. The Hospital VBP Program score will be used when it results in a higher combined quality and cost score than the MIPS quality measure data you submit and MIPS cost measure data CMS calculates for you.

In 2021, CMS will use claims data to assess individual ECs and their groups on the following twenty (20) cost measures. 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 20% weighting will be redistributed to the Quality performance category.

Visit the ASA Cost performance category FAQs for more information.

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)
  • Knee arthroplasty
  • Revascularization for lower extremity chronic critical limb ischemia
  • Routine cataract removal with intraocular lens (IOL) implantation
  • Screening/surveillance colonoscopy
  • 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

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)

Cost measure specifications and regulatory information are available on the Quality Payment Program Resource Library website. ASA continues to advocate for physician anesthesiologists to be fairly and accurately assessed under the MIPS cost category.