What is the Quality Payment Program?
The Quality Payment Program improves Medicare by helping eligible clinicians focus on care quality and making patients healthier.
In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, repealing the Sustainable Growth Rate (SGR) payment system which governed how physicians and other clinicians were paid under Medicare Part B. MACRA replaced the SGR, and its fee-for-service reimbursement model, with a new two-track value-based reimbursement system called the Quality Payment Program (QPP). This program is the latest in a series of steps the Centers for Medicare and Medicaid Services (CMS) has taken to incentivize high quality of care over service volume.
The Quality Payment Program went into effect on January 1, 2017 and has two paths for participation:
- The Merit-based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (APMs)
For the 2017 performance period (January 1, 2017 through December 31, 2017), Medicare Part B providers who meet the definition of a MIPS eligible clinician will be required to participate successfully in one of the QPP tracks in order to avoid a negative payment adjustment in 2019. This center is intended to provide information that can guide Medicare providers as they look to understand and implement the QPP in their own practices. Click any of the links below to learn more.
Source : Centers for Medicare and Medicaid Services. Quality Payment Program webinar slides. October 26, 2016.
What is MIPS?
MACRA combines Medicare incentive programs into one single program: the Merit-Based Incentive Payment System (MIPS).
What are APMs?
MACRA allows providers who take further steps towards transforming healthcare to be exempt from MIPS and participate in Advanced Alternative Payment Models (APMs).
How to prepare
Individual eligible providers can prepare to meet all MIPS measures and be ready to avoid penalties and earn bonuses on January 1, 2017.
In this new MIPS performance category, clinicians are rewarded for care focused on care coordination, beneficiary engagement, and patient safety.
The MIPS Quality category replaces the Physician Quality Reporting System (PQRS)