menu toggle

Managing cost is a key driver for value-based care


The Cost component under MIPS reporting is 30% of the overall score for 2023. Yet, how do you know how your practice and providers are doing when data from Medicare can take up to 18+ months, typically six to eight months after the performance year is over? Your practice cannot make those necessary course corrections to impact your score in that Cost category.

Historical performance data may not help as measures were not scored during the pandemic and most measures have been changed or were created as new measures since that period. To understand the data, you also need to know that you are not scored on your costs alone, but the total cost of care for that patient – by any provider.

Managing your costs is essential for value-based care reimbursements.

How can we help?

The MIPS consulting team can utilize a cost analytics tool – giving you more timely related data from CMS. The tool allows you to see your score estimate on all cost measures and your attribution for those measures. This will help you identify what measures you need to focus on and any impacts you can make in the current year for your performance.

The data will be benchmarked on available national data, and you will be able to drill down to see specific clinician information. The data will allow you to focus on areas of higher cost or lower quality to create an action plan for your practice.

If you sign up for the tool, the team will request your data from CMS (which can take anywhere from one to four months, depending on when you ask. That data will refresh quarterly – not the six to eight months after the submission period.

Understanding the costs related to your patients may in turn improve your HCC risk coding, allow you to monitor your referral network and identify and support those patients who need it most, particularly those who are the costliest.

The information provided is directly related to how CMS will calculate benchmarks for specific cost measures.

Our MIPS consulting team is ready to answer questions about the new Cost Analytics Tool – and talk about what they can do to help identify and offer options for your own practice’s touchpoints related to Cost measures. 

Contact them at: