CMS bolstered the emphasis on cost containment by making MIPS Cost 10% of the MIPS score in 2018. Additionally, the Bipartisan Budget Act of 2018 passed last Friday modifies MIPS through the “MIPS Transition Modifications”, and will impact on cost. Cost and utilization performance, as measured by existing and new MIPS cost measures, usually require long lead times to diagnose, plan and execute for improvement. Clinicians with high exposure to MIPS cost measures, such as specialists, are increasingly paying attention and asking what they can do now to maximize performance starting in 2018 and continually improve towards 2019 and beyond. We share insights and best practices from the field and available data.