Medicare Quality Payment Program

On October 14, 2016 the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program.

The Quality Payment Program seeks to transform Medicare payments for more than 600,000 clinicians nationwide, and is a significant step in improving care across the health care system.

New Quality Payment Program Resources Available for the 2018 Performance Period

CMS Releases 2018 Electronic Clinical Quality Measures (eCQMs) for Eligible Professionals/Clinicians 

How does the Medicare Access & CHIP Reauthorization Act (MACRA) reform Medicare payment?

The MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. These changes create a Quality Payment Program (QPP):

  • Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services
  • Making a new framework for rewarding health care providers for giving better care not just more care
  • Combining existing quality reporting programs into one new system

These proposed changes replace a patchwork system of Medicare reporting programs with a flexible system that allows providers to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

MACRA also required CMS to develop and post a Quality Measure Development Plan that gives a framework for making clinician quality measures to support the MIPS and APMs.

What is the MACRA Quality Payment Program?

The MACRA QPP will help us to move more quickly toward the goal of paying for value and better care. The Quality Payment Program has 2 paths:

  1. Merit-Based Incentive Payment System
  2. Alternative Payment Models

These will go into effect from 2015 through 2021 and beyond.

What is the Merit-Based Incentive Payment System (MIPS)?

The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on:

  • Quality
  • Resource use
  • Clinical practice improvement
  • Meaningful use of certified EHR technology

What are Alternative Payment Models (APMs)?

APMs give us new ways to pay health care providers for the care they give Medicare beneficiaries. For example:

  • From 2019-2024, pay some participating health care providers a lump-sum incentive payment.
  • Increased transparency of physician-focused payment models.
  • Starting in 2026, offers some participating health care providers higher annual payments.

Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.

For more information, see the Quality Payment Program fact sheet and implementation timeline.


Docs Left In The Dark Again About MIPS Requirements - January 23, 2018

CMS Allows More Docs to Sit Out MACRA - November 2, 2017