Prior cost measure development and input 

Learn about prior measure development and past cost category work from:

Wave 6 initial cost measure development (2023-2024)

• Summary of Wave 6 Workgroup Meetings (ZIP) contains a high-level summary for the measure-specific workgroup meetings held in 6/2023.
• Summary of Wave 6 Service Assignment and Refinement (SAR) Workgroup Meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 10/2023.

• Summary of Wave 6 Post-Field Test Refinement (PFTR) Workgroup Meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 3/2024 to discuss final refinements to the measures.

  Wave 6 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in 6/2023 to give detailed clinical input on the measure specifications for the episode groups being developed in Wave 6.

• Episode-Based Cost Measure Specifications (ZIP) includes the current cost measure methodology and cost measure codes lists for each of the 2 episode-based cost measures developed during Wave 6. Section 3 of each measure methodology document contains a high-level summary of the measure specifications.
• Wave 6 Measure Justification Forms (ZIP) contain Measure Justification Forms for the two episode-based cost measures that provide a comprehensive characterization of the measures, their justification, and testing results of these measures’ specifications at the end of initial development.

Wave 6 initial cost measures field testing

From February 1 to March 14, 2024, we field tested 2 newly developed Wave 6 episode-based cost measures for consideration in MIPS. During field testing, eligible clinicians and clinician groups were able to download their Field Test Reports from the Quality Payment Program website and give feedback on the draft measure specifications. These reports were for field testing only, and don’t affect any scoring or payment adjustments.

Learn more:

• Frequently Asked Questions (FAQ) (PDF) gives you information about the cost measures and field testing in a question and answer format.
• Wave 6 Measure Development Process (PDF) describes our approach to measure development.
• User Access Guide (PDF) explains how to access your Field Test Report(s) on the Quality Payment Program website.
• Mock Field Test Reports (ZIP) contains sample Field Test Reports that are representative of each reporting level. Each ZIP file includes a PDF Field Test Report, a supplemental comma-separated values (CSV) file with episode-level data, and the data dictionary for the metrics used in the CSV file.

You can also review the supplemental documents for the 2 episode-based cost measures:

• Questions for Field Testing Measure Specifications (PDF) contains questions on the specifications of each of the measures as included in the online field testing survey and accompanies the draft specifications for each measure.
• Person and Family Engagement (PFE) Cost Measures Field Testing Feedback Survey (PDF) contains questions on the measures being field tested as included in the online PFE survey, and it is intended for patient and family/caregiver input.
• Field Testing Feedback Summary Report (PDF) summarizes the feedback from interested parties on the 2 episode-based cost measures that were field tested as part of the measure development process.
• Wave 6 Measure At-A-Glance Summary Sheets (ZIP) provide high-level, plain language overviews of the 2 episode-based cost measures after incorporating feedback from initial 2024 field testing. 
   

Cost measure comprehensive reevaluation (2023-2024)

• 2023 Comprehensive Reevaluation Public Comment Summary Report (PDF) describes input received during the initial MACRA Episode-Based Cost Measures Comprehensive Reevaluation public comment period requesting public feedback on MSPB Clinician, TPCC, and the episode-based cost measures developed during Wave 2, which was held from June 27, 2023, to July 21, 2023.
• 2024 Public Comment Summary Report for the Comprehensive Reevaluation of the Total Per Capita Cost (TPCC) Measure (PDF) describes input received during the second round of public comment on the comprehensive reevaluation of the TPCC measure requesting public feedback on potential refinements to the TPCC measure, which was held from April 25, 2024, to May 17, 2024.
   

Wave 5 cost measure development (2022-2023)

• Wave 5 Public Comment Summary Report (PDF) describes input received during the Wave 5 pubic comment period on candidate measure areas, which was held from February 18, 2022 to April 1, 2022, and provides brief responses to feedback.
• Summary of Wave 5 Workgroup Meeting (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in in 7/2022.
• Summary of CKD/ESRD Workgroup Webinar (PDF) provides discussion summaries and high-level takeaways for the meetings held in 9/2021 and 10/2021.
• Summary of Wave 5 Service Assignment and Refinement (SAR) Workgroup Meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 9/2022 and 10/2022.
• Summary of Wave 5 Post-Field Test Refinement (PFTR) Workgroup Meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 4/2023 to discuss final refinements to the measures.
• Summary of CKD/ESRD Post-Field Test Refinement (PFTR) Workgroup Meeting (PDF) contains a high-level summary of the workgroup meeting held in 3/2023 to discuss final refinements to the measures.
• Wave 5 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in 7/2022 to give detailed clinical input on the measure specifications for the episode groups being developed in Wave 5.
• CKD/ESRD Clinician Expert Workgroup Composition List (PDF) is the list of members of the workgroup that met beginning in 9/2021 to give detailed clinical input on the measure specifications for the CKD/ESRD measures.
• Wave 5 Measure Justification Forms (ZIP) contain Measure Justification Forms for the 5 episode-based cost measures that provide a comprehensive characterization of the measures, their justification, and testing results of these measures’ final specifications.

Wave 1 cost measure comprehensive reevaluation (2022-2023)

In February 2023, we requested input on potential revisions to 3 episode-based cost measures undergoing comprehensive reevaluation before consideration of their use in the Merit-based Incentive Payment System (MIPS):

• Cataract Removal with Intraocular Lens (IOL) Implantation (currently Routine Cataract Removal with Intraocular Lens (IOL) Implantation)
• Inpatient Percutaneous Coronary Intervention (PCI) (currently ST-Elevation Myocardial Infarction [STEMI] with PCI)
• Respiratory Infection Hospitalization (currently Simple Pneumonia with Hospitalization)

Note: Any substantive changes to the measure are required to go through the notice-and-comment rulemaking process before being finalized for use in the Merit-based Incentive Payment System (MIPS).

You can also review the updated supplemental documents:

• Measure Testing Forms (ZIP) has detailed testing results for the 3 episode-based cost measure.
• Summary of Wave 1 Comprehensive Reevaluation Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in October 2022. Workgroup members gave input on potential revisions to cost measures undergoing comprehensive reevaluation.
• Wave 1 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in October 2022 to give input on potential revisions to cost measure undergoing comprehensive reevaluation.
• Wave 1 Comprehensive Reevaluation Public Comment Summary Report (PDF) describes input received during the initial MACRA Episode-Based Cost Measures Comprehensive Reevaluation public comment period, which was held from February 25, 2022 to May 28, 2022.
• 2023 Revised Cost Measure Feedback Period Summary Report (PDF) describes input received during the second Wave 1 comprehensive reevaluation public feedback period, which was held in February 2023.
• Summary of Wave 1 Post-Feedback Period (PFR) Workgroup Meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in April/May 2023 to discuss final refinements to the measures.  
• Wave 1 Reevaluated Measure Justification Forms (ZIP) contain Measure Justification Forms for the 5 episode-based cost measures that provide a comprehensive characterization of the measures, their justification, and testing results of these measures’ final specifications.  

Wave 4 cost measure development and refinement (2021-2022)

• Wave 4 Measure Development Process (PDF) describes our approach to measure development.
• Wave 4 Public Comment Summary (PDF) describes input received during the Wave 4 public comment period on candidate measure areas, which was held from December 15, 2020, to February 5, 2021, and provides brief responses to feedback.
• Summary of Wave 4 Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 6/2021 to give detailed input on each component of the cost measure.
• Summary of Psychoses/Related Conditions Workgroup Webinar (PDF) provides discussion summaries and high-level takeaways from the 10/2021 workgroup meeting.
• Summary of Wave 4 Service Assignment & Refinement (SAR) Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held on 9/2021 and 10/2021.
• Summary of Wave 4 Post-Field Test Refinement Webinar (PFTR) Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 4/2022.
• Summary of Psychoses/Related Conditions Post-Field Test Refinement (PFTR) Webinar (PDF) provides discussion summaries and high-level takeaways from the 4/2022 meeting on refinement topics based on field testing feedback.
• Wave 4 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in 6/2021 to give detailed clinical input on the measure specifications for the 4 episode groups being developed in Wave 4.
• Psychoses/Related Conditions Clinician Expert Workgroup Composition List (PDF) is the list of members of the workgroup that met in 10/2021 to give detailed clinical input on potential refinements to the Psychoses/Related Conditions measure.
• Wave 4 Measure Justification Forms (ZIP) contain Measure Justification Forms for the 5 episode-based cost measures that provide a comprehensive characterization of the measures, their justification, and testing results of these measures’ final specifications.

Wave 3 cost measure development (2019-2020)

• Wave 3 Measure Development Process (PDF) describes our approach to measure development.
• The Wave 3 Measure Justification Forms (ZIP) contain Measure Justification Forms for the 5 episode-based cost measures that provide a comprehensive characterization of the measures, their justification, and testing results.
• Updated 2020 National Summary Data Report (ZIP) contains an updated report that provides national-level summary statistics on clinicians’ performance for the cost measures following refinements made after the field testing period, as well as an addendum with risk adjustment regression results for the cost measures.
• Testing Updates for Wave 3 (PDF) provides updated information on empirical validity for the Wave 3 measures, including the relationship to related MIPS quality measure and the global cost of care TPCC measure.
• Summary of Wave 3 Clinical Subcommittee (CS) and Workgroup meetings & Wave 3 Measure-Specific Workgroup Composition List (ZIP) contains a high-level summary of each of the Clinical Subcommittee meetings and measure-specific workgroup meetings held from 5/2019 – 10/2020, and the list of members of the measure–specific workgroups that met in 8/2019 to give detailed clinical input on the measure specifications for the 5 episode groups being developed in Wave 3.
• Summary of Person and Family Engagement (PFE) and Input (PDF) contains a summary of how PFE has been incorporated in measure specifications for the Wave 3 measures.

Wave 2 cost measure development (2018)

• Waves 1 & 2 measure development process (PDF) describes our approach to Waves 1 and 2 of cost measure development.
• The Wave 2 Measure Justification Forms (ZIP) contains Measure Justification Forms for the 11 episode-based cost measures and the revised TPCC and MSPB measures that contain a comprehensive characterization of the measures, their justification, and testing results.
• Updated 2018 National Summary Data Report (ZIP) contains an updated report that provides national-level summary statistics on clinicians’ performance for the cost measures following refinements made after the field testing period, as well as an addendum with risk adjustment regression results for the cost measures.
• Person and Family Committee (PFC) Input for Wave 2 Episode-Based Cost Measure Development (PDF) is a summary of input we got from the PFC on the 11 episode-based cost measures developed in Wave 2.

Prior cost measure feedback requests 

• Prior cost measure field testing
  • 2017 Field Testing materials (ZIP) contains field testing documents for the 8 episode-based cost measures that were developed in Wave 1 and field tested from 10/16/2017 - 11/20/2017. During that time, we collected feedback (PDF) to refine the measures before we decided whether to use them in MIPS.
  • 2018 Field Testing materials (ZIP) contains field testing documents for the 11 Wave 2 episode-based cost measures and 2 revised measures that were field tested between 10/3/2018 - 11/05/2018. During that time, we collected feedback (PDF) to refine the measures before we decided whether to use them in MIPS.
  • 2020 Field Testing materials (ZIP) contains field testing documents for the 5 Wave 3 episode-based cost measures that were field tested between 8/17/2020 - 09/18/2020. During that time, we collected feedback (PDF) to refine the measures before we decided whether to use them in MIPS.
  • 2022 Field Testing Materials (ZIP) contain field testing documents for the 5 Wave 4 episode-based cost measures that were field tested between 1/10/2022-3/25/2022. During that time, we collected feedback (PDF) to refine the measures before we decided whether to use them in MIPS.
  • 2023 Field Testing Materials (ZIP) contain field testing documents for the 5 Wave 5 episode-based cost measures that were field tested between 1/17/2023-2/14/2023. During that time, we collected feedback (PDF) to refine the measures before we decided whether to use them in MIPS.
     
• 2018 study on burdens associated with reporting quality measures (PDF) to get improvement activity credit for 2018.
• The MACRA Request For Information (RFI) (PDF).
• The Draft CMS Quality Measure Development Plan (MDP) (PDF).
• The 2018 Annual Call for Advancing Care Information Measures & Improvement Activities fact sheet (ZIP).
• Previous episode groups summary and details (ZIP) and supplemental episode groups materials (ZIP).
• Draft list of episode groups and trigger codes (ZIP) (12/2016).