Most of us don’t worry about the cost category because we don’t have to submit any data for this measure, it is simply calculated from our claims. Well, it is time to start worrying about this measure since CMS upped it to 15% of your final MIPS score. So, how do we make sure we are “meeting” this measure? Well, it’s complicated.
I could sit here and bore you with a ton of CMS calculations of total per capita cost and Medicare spending per beneficiary, but I don’t want to do that. You know I like to keep things as simple as possible. The bottom line is that CMS wants to keep cost (hence the name of this measure) as low as possible. The calculations I mentioned before are a way for CMS to find out how much they should be spending on each beneficiary verses how much they are spending on each beneficiary. In this measure, each provider is attributed several Medicare beneficiaries based on amount of care given to the patient by each provider treating them over the reporting period. The provider that administers the most care to each beneficiary or patient is the provider that has that patient attributed to them in this measure.
So, how do we make sure we are being as responsible as possible with CMS funds to in turn receive the highest score for this category? It is very simple, keep costs to CMS as low as possible. Obviously, providers ultimately know what is best for their patient. This measure just asks them to do as much research as possible to assure they are using the most cost-effective treatments for patients. Some examples are using a less expensive drug that will have the same outcome on a patient as the more expensive alternative or being very conservative with the 25 modifier on E&M codes. These are small things that will lower the overall cost to Medicare but won’t have much impact on your overall revenue.