MIPS Cost Performance Category

For the 2022 performance year, eligible clinicians and groups will 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.

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 2023 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.

In 2022, 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). 

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
  • Melanoma Resection
  • 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)
  • Sepsis

Chronic condition episode-based

  • Asthma/Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes

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.