APMA News - May/June 2018 - 61
Reimbursement
*
performance period and received the plurality of his or
her primary care services from the specialist.
Medicare Spending Per Beneficiary (MSPB).7 The MSPB
measure is based upon all Part A and Part B spending
during episodes triggered by inpatient hospitalizations.8,9
Each episode is attributed to the physician providing the
plurality of Part B clinician services during the admission, regardless of the service types provided or the physician's specialty.
Each physician's or group's score is calculated using Medicare claims data only for beneficiaries attributed to that physician or group, based upon each measure's specifications and
attribution rules. A physician or group must have at least 20
attributed patients for the TPCC measure to be scored, and at
least 35 episodes for the MSPB measure to be scored. If there
are not enough cases for either measure to be scored, the cost
category weight will be reduced to 0 percent, and the weight
will be redistributed to the Quality category.
For each measure, performance is compared to a national
benchmark, and the performance is converted to a point score
7
8
9
10
(0-10 points). Points from all scorable measures are added,
and the sum is divided by the total possible points (10 points/
measure scored) to yield the Cost performance category score.
Future Directions
CMS is currently developing additional episode-based cost
measures to be added to the Cost performance category, including measures that may be applicable to podiatrists. CMS is also
exploring if and how to incorporate patient relationship categories into cost measurement. Clinicians can now voluntarily report Level II HCPCS modifiers that reflect five patient relationship categories that CMS operationalized last year.10 These
codes are intended to facilitate the attribution of patients
and care episodes to clinicians who serve patients in different roles.
n
For questions about any of these issues, contact the
Health Policy and Practice department at healthpolicy.
hpp@apma.org.
Some of the specifications for this measure have changed relative to the measure under the VM program.
Episodes span from three days prior to a hospital admission through 30 days after hospital discharge.
Costs are standardized, risk adjusted, and adjusted for outliers before they are finalized.
Categories and Level II HCPCS codes are as follows: Continuous/broad services-X1; Continuous/focused services-X2; Episodic/broad
services-X3; Episodic/focused services-X4; Only as ordered by another clinician-X5.
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APMA News May/June 2018
61
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APMA News - May/June 2018 - Cover1
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APMA News - May/June 2018 - Contents
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