Quality Payment Program

How the Quality Payment Program (QPP) will impact your healthcare organization

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was the largest change in a generation to move healthcare reimbursement from fee-for-service to pay-for-value. MACRA replaces the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula with a new value-based reimbursement system called the Quality Payment Program (QPP).

The QPP provides two paths for clinicians to earn Medicare Part B reimbursement:

  • The Merit-based Incentive Payment System (MIPS)
  • Alternative Payment Models (APMs)

MIPS Snapshot

  • Competitive program that scores clinicians across multiple performance categories
  • Each category has its own set of measures, requirements, scoring, and reporting
  • Annual MIPS score will determine Medicare reimbursement adjustments
  • MIPS scores will be publicly reported on the Physician Compare website and made freely available to third-party vendors

APMs Snapshot

  • CMS-defined value-based payment program models based on specific clinical conditions, care episodes, or populations
  • Participation requirements must meet the model as well as the entity’s individual requirements
  • Qualifying participants can earn an annual 5% Part B incentive and are exempt from MIPS

Decisions, Decisions

Organizations and clinicians have to decide which path to take – MIPS versus APM – as well as how to participate, what measures to select, how to report, and much more.

Regardless of which path you choose, the amount and complexity of management and reporting will increase significantly. We have helped thousands of providers maximize performance in the QPP with our Population Health suite of software and expert services.

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