1. 2019 MIPS Cost Performance Category
Reporting Guide for CRNAs
The AANA Research and Quality department prepared this is a brief overview of MIPS Quality performance category in 2019, as it applies to CRNAs who are eligible to participate in MIPS. This is Year 3 of the MIPS program.

2. MIPS Reporting Categories
Quality
Improvement Activities (IA)
Promoting Interoperability (PI)
Cost*
*Anesthesia services are included in the Cost measures, although they do not trigger measure calculation.
Cost is one of the four performance categories MIPS Eligible Clinicians (EC) can report. CRNAs are included as eligible clinicians
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3. Cost Performance Category
The Cost Performance Category replaces the legacy Value Modifier program
Medicare claims data are used to calculate total cost of care, so clinicians do not have additional administrative burden (data collection or report submission)
Data is collected for an entire calendar year (January 1st to December 31st), which is called the performance period.
MACRA replaced the Value Modifier program, but components are included in the Cost Performance category. Eligible clinicians must meet participation criteria, including volume threshold.
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4. Cost Measures Total Per Capita Cost (TPCC)
Medicare Spending per Beneficiary (MSPB)
8 Episode-Based Cost Measures:
The 2018 specifications for the TPCC and MSPB measures will also be used in 2019.

5. Cost Performance Category Weighting
45% final Score
(for CRNAs reporting PI* with applicable Cost Measures)
70% final Score
(for CRNAs NOT reporting PI*, but with applicable Cost Measures)
85% of final score
(for CRNAs NOT reporting PI* with NO applicable Cost Measures)
*PI – Promoting Interoperability
This illustrates the weights of each performance category in relation to the MIPS Final Score, which is calculated as percentage. If no Cost Measures apply to the EC or group, the performance category will be reweighted to the Quality category.
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6. 2019 Medicare Spending Per Beneficiary Measures
The MSPB Measure compares total observed Medicare Part A & B costs incurred by a single beneficiary 3 days prior to, during and 30 days after a qualifying inpatient hospital stay, to the expected costs for specified chronic conditions or procedures.
Measure includes hospital admissions that occur during the performance period. The episode window is 3 days before hospital admission through 30 days after hospital discharge. Services can also include outpatient and Durable Medical Equipment (DME). The MSPB case volume threshold is 35.

7. 2019 Medicare Spending Per Beneficiary (cont.)
Numerator and denominator used to calculate MSPB measure for individual clinicians and groups:
*Additional information is available in the 2018 MSPB Measure Information Form
This demonstrates how the MSPB measure is calculated for individual clinicians and for group.

8. Attribution of MSPB Measure
The measure is attributed to the MIPS EC who provides the most Medicare Part B physician or supplier services for chronic disease during the period between the hospital admission date and the discharge date.
CMS attributes episodes at the clinician level, using the unique TIN-NPI.
For clinicians reporting as a group, a single measure score is calculated and assigned to the group.

9. 2019 Total Per Capita Cost Measure
Total Per Capita Cost (TPCC) measure evaluates data from Medicare Part A & B claims. The costs of primary care services provided to beneficiaries by an individual provider or group are divided by the number of beneficiaries attributed to that provider or group.
Items and services related to primary care are the focus of the measure. Attribution is not made to a specialist unless a primary provider was not involved in care during the performance year.
The TPCC measure is reported at the TIN-NPI level.
Additional information is available from the 2018 TPCC Measure Information Form
Costs are associated with inpatient and outpatient services to a beneficiary during the performance period. TPCC case volume threshold is 20; Risk-adjustment is calculated from Hierarchical Chronic Conditions. Compares actual costs to average costs. Measure is expressed at the TIN level
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10. Attribution for the TPCC Measure
There is a two-step attribution process for the TPCC Measure:

11. 2019 Episode-Based Cost Measures
Consist of procedural and acute inpatient medical condition episode groups
Measures only the items and services provided for an episode of care for a clinical condition or procedure
Calculated using Medicare Part A & B claims data
Anesthesia services are included in seven of the eight episode-based cost measures.* *
Anesthesia is not usually included service under the Pneumonia episode Cost Measure. CRNAs may be attributed Pneumonia episode cost measure if they are part of a multi-specialty group.

12. Attribution of Episode-Based Cost Measures
Acute Inpatient Medical Condition Episode Group - Each MIPS EC who bills the majority of Medicare Part B claims for the admission
Procedural Episode Group – Each MIPS EC who renders a triggering service identified by HCPCS/CPT codes
CRNAs don’t usually bill majority of Medicare Part B claims or provide services that trigger HCPCS/CPT codes used in Cost Measures
CRNAs and anesthesia services are in included services for episode-based measures. The EC that bills the majority of the claims for the admission episode gets credit for the measure.
*Add source (location in document)

13. Risk Adjustment for Cost Measures
Claims data for TPCC, MPSB and the episode-based measures are risk adjusted, which accounts for patient characteristics that are beyond a clinician’s control and can impact spending on services.
Risk factors come from beneficiaries’ Medicare claims history (e.g. geographical costs or complex medical history)

14. Cost Performance Category Scoring
Clinicians can earn from 1 up to 10 measure achievement points for each measure
Cost measures are attributed to clinicians at the TIN or NPI level. Performance scoring is made for individual practitioners or groups.
Performance scores are compared to a single, national benchmark based on data from the performance period
Performance feedback on 2019 Cost data will be made available Summer 2020

15. Additional Resources
Quality Payment Program website:
QPP Resource Library:
Fact Sheet
Cost Measure Information Form
Cost Measure Code List
Phone: (Monday through Friday)
CMS offers resources in print, video and webinars to assist you with 2019 MIPS reporting requirements.