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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.

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 MIPS

MIPS 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 APM

APMs Overview

Additional Resources

Executive Summary of the QPP Final Rule(pdf 204KB)QPP Fact Sheet(pdf 266KB)QPP Key Objectives Information Sheet(pdf 592KB)

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