Quality Payment Program Overview
Prior to the Quality Payment Program (QPP), payment increases for Medicare services were set by the Sustainable Growth Rate (SGR) law. This capped spending increases according to the growth in the Medicare population, and a modest allowance for inflation.
However, as clinicians increased their utilization of services, the reimbursement for each unit of service had to be adjusted downward to hold costs constant. In practice, the SGR would have resulted in large decreases in the Physician Fee Schedule, which was not sustainable. To avoid these decreases in reimbursement, Congress had to pass a new law (every year) authorizing the current fee schedule and a small increase for inflation.
With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS did away with the SGR. Now, we are able to reward high value, high quality Medicare clinicians with payment increases - while at the same time reducing payments to those clinicians who aren’t meeting performance standards.
CMS seeks to improve Medicare by helping clinicians focus on caring for their patients rather than filling out paperwork. CMS will continue to listen and take steps towards reducing burdens for clinicians, and improving health outcomes for Medicare patients.
Clinicians have two tracks to choose from in the Quality Payment Program based on their practice size, specialty, location, or patient population:
- Merit-based Incentive Payment System (MIPS) or
- Advanced Alternative Payment Models
QPP started on January 1, 2017.
Objectives of the Program
Over 100,000 physicians and other stakeholders attended our outreach sessions. You’ve given us more than 4000 comments. From this process and your input, we’ve arrived the following program objectives:
- To improve beneficiary population health
- To improve the care received by Medicare beneficiaries
- To lower costs to the Medicare program through improvement of care and health
- To advance the use of healthcare information between allied providers and patients
- To educate, engage and empower patients as members of their care team
- To maximize QPP participation with a flexible and transparent design, and easy to use program tools
- To maximize QPP participation through education, outreach and support tailored to the needs of practices, especially those that are small, rural and in underserved areas
- To expand Alternative Payment Model participation
- To provide accurate, timely, and actionable performance data to clinicians, patients and other stakeholders
- To continuously improve QPP, based on participant feedback and collaboration
The Quality Payment Program Has Two Participation Tracks
Merit-based Incentive Payment System
In MIPS, you may earn performance-based payment adjustments for the services you provide to Medicare patients.
Explore how you can participate in MIPSMIPS Overview
Alternative Payment Model
An APM is a customized payment approach developed by CMS, often designed to provide incentives to clinicians who are providing high-quality, high value care. APMs can focus on specific clinical conditions, care episodes, or populations.
Explore how you can participate in an APMAPMs Overview