CMS Trying to Figure out "Cost" portion of MIPS

MIPS - The Merit Based Incentive Payment System has 4 components
Advancing Care Information
Quality Reporting
Practice Improvement Activities
Resource Use (Cost)
The Resource Use component was weighted at 0% for 2017 and for 2018, but the law states that Resource Use must be weighted at 30% for the 2019 performance year. This has caused a great deal of concern in the provider community in that how Resource Use will be calculated is not well understood. CMS is still trying to figure out how it will calculate resource use and is initiating a pilot program to look at costs associated with the following procedures and medical conditions:

percutaneous coronary intervention
knee arthroplasty
cataract removal
lower limb revascularization
colonoscopy
intracranial hemorrhage
and pneumonia

It is not yet clear how this pilot program will impact providers who do not provide the procedures listed or provide care for the conditions listed.

The pilot program includes reports that have been created for about 17,000 medical practices based on claims data from June 1, 2016 through May 31, 2017. A CMS has hired Acumen to work with these practices and review their reports for data accuracy. The data is then expected to be used as a benchmark for the procedures and medical conditions and CMS will develop a method of calculating the Resource Use of the MIPS equation.

Much of this aspect of MIPS is still unclear, and how the data will be used to calculate Resource is still not known. CMS is under the gun to get this rolled out for 2019 and they need to publish the scoring metrics well in advance if they intend to meet the mandate of the law. The questions still remain as to what the program will be and will CMS get the program out in time for the 2019 year, and what will happen with the MIPS program should CMS miss this deadline.

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