What are cost measures in MIPS and how are they calculated?

• A. Cost measures assess physician satisfaction.
• B. Cost measures assess resource use for quality outcomes; calculated using claims data and provider-specific cost reports.
• C. Cost measures are based on patient age.
• D. Cost measures are the same as quality measures.

Answer: (B)

Cost measures in MIPS focus on how much care resources are used to achieve outcomes, tapping into the spending side of care rather than satisfaction or age. They capture resource use and efficiency, showing whether more or fewer services and costs are associated with quality results.

These measures are calculated from two main data sources. First, claims data record what services were actually delivered to patients and the payments tied to those services, giving a detailed view of resource use across episodes of care. Second, provider-specific cost reports supply the actual costs from the provider’s perspective, allowing costs to be valued in a way that reflects local pricing and operating realities. By combining what was done (claims) with what it cost (cost reports), CMS can estimate total costs for care for individuals or episodes and compare performance across clinicians or practices.

It’s important to distinguish cost measures from quality measures. Cost measures gauge resource use and spending tied to outcomes, whereas quality measures evaluate adherence to clinical standards and outcomes themselves.