Thankful for Positive Change: CMS’ New MIPS Cost Scoring Approach
We’re taking a moment to reflect on the positive policy changes that the Centers for Medicare and Medicaid Services (CMS) finalized for MIPS. One of these is the new cost scoring methodology, which is a significant step towards more accurately measuring and rewarding clinicians for the value of the care they provide.
How Will Cost Be Scored?
Beginning with the 2024 performance year, CMS will no longer assign cost measure points based on a clinician’s or group’s percentile ranking. Instead, the median cost for a given measure will be set at 7.5 points, and points for other deciles will be determined by standard deviations from the median.
The following table compares the previous system with the new approach:
| Points | Previously: Cost Percentile | Finalized: Cut Offs |
| 1 – 1.9 | 99th+ (highest costs) | Median cost ($) + (2.75 x standard deviation ($)) |
| 2 – 2.9 | 90th – 81st | Median cost ($) + (2.5 x standard deviation ($)) |
| 3 – 3.9 | 80th – 71st | Median cost ($) + (2.25 x standard deviation ($ |
| 4 – 4.9 | 70th – 61st | Median cost ($) + (2 x standard deviation ($)) |
| 5 – 5.9 | 60th – 51st | Median cost ($) + (1.5 x standard deviation ($)) |
| 6 – 6.9 | 50th – 41st | Median cost ($) + (1 x standard deviation ($)) |
| 7 – 7.9 | 40th – 31st | Median cost ($) + (0.5 x standard deviation ($)) |
| 8 – 8.9 | 30th – 21st | Median cost ($) – (0.5 x standard deviation ($)) |
| 9 – 9.9 | 20th – 11th | Median cost ($) – (1 x standard deviation ($)) |
| 10 | 10th – 1st (lowest costs) | Median cost ($) – (1.5 x standard deviation ($)) |
Why Is the New Scoring Change Important?
Under the previous system, MIPS participants who reported on measures with limited cost variation were at risk of being assigned inappropriately low scores. Clinicians with the lowest average cost per episode or beneficiary were placed in the top decile and received the most points, while clinicians with the highest average cost were placed in the bottom decile and received the fewest points.
In cases where cost variation was minimal, a clinician scoring close to the median on a cost measure would need to score nearly perfectly across the other three MIPS categories just to receive a final score slightly above the performance threshold and avoid a negative payment adjustment. This was particularly noticeable in efficient procedures like cataract surgery.
The new scoring methodology reduces the likelihood of inappropriately low scores. CMS expects that MIPS participants with average costs near the median will receive scores close to the performance threshold-derived score (threshold to avoid a penalty divided by 10), which will more accurately reflect the level of care they provide. For example, in 2024 and 2025, the threshold to avoid a penalty is 75 points, so the median cost for any given Cost measure will be assigned 7.5 points out of 10.
What Will 2024 Cost Scores Look Like?
We anticipate that many of our clients will see an improvement in their cost scores under the new methodology. Additionally, if your score does improve, you will also receive the cost improvement score of up to 1% added to your total cost measure achievement points.
Next Steps
- Share this information with your colleagues.
- Subscribe to our blog to get alerts on this and other important issues. You can subscribe using the field in our website footer below.
- If you are an Anatomy IT client, contact your MIPS Expert if you have any questions.
- If you are not an Anatomy IT client, contact us to learn more about our MIPS Success Plan and to reap the rewards of our combined decades of experience.
Written By: Sarrah Hakim, MHSA
About the Author: Sarrah is a Manager of Health Policy at Anatomy IT.
