Changes in the MIPS 2019 Proposed Rule: Cost Category

By Featured article

The Centers for Medicare & Medicaid Services (CMS) recently issued its Proposed Rule for 2019 under the Quality Payment Program. In this week’s blog we examine changes in the Cost performance measure category.

CMS continues to place increasing emphasis on cost and quality for MIPS Reporting.
In the Cost category, CMS will continue to look at claims data, but the performance measure will be weighted more heavily each year. The percentage increases five percent each year, topping off at 30 percent of the total. In 2019, the proposed weighting will be 15 percent, up from 10 percent in the 2018 performance year.
The Total Per Capita Cost (TPCC) and Medicare Spending per Beneficiary (MSPB) measures will work similar to past years. Benchmarks will be made based on comparisons to your peers in your specialty but will not look at historical data.
If your practice does not meet the minimums (applicable to your practice or provider), your cost category moves to additional weighting on your Quality performance measure. You will be scored on as many measures that meet the case minimum. If only one measure can be scored, that score will be the total Cost category score.
CMS is proposing to add eight new episode-based measures that were field tested in 2017. The measures include:

  • Elective Outpatient Percutaneous Coronary Intervention (PCI)
  • Knee Arthroplasty
  • Revascularization for Lower Extremity Chronic Critical Limb Ischemia
  • Routine Cataract Removal with Intraocular Lens (IOL) Implantation
  • Intracranial Hemorrhage or Cerebral Infarction
  • Simple Pneumonia with Hospitalization
  • ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)


The comment period for the 2019 Proposed Rule closed in September. We expect the Final Rule on the proposals above to be released in November.

If you have additional questions about the 2019 Proposed Rule or questions about MIPS reporting, contact the Quality Reporting Engagement Group at

This information was taken from the InfoDive Coding and Audits webinar held in November 2018.