Critical Issues

Medicare Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is bipartisan legislation that was signed into law on April 16, 2015. MACRA created the Quality Payment Program that:

• Repeals the Sustainable Growth Rate (PDF) formula
• Changes the way that Medicare rewards clinicians for value over volume
• Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
• Gives bonus payments for participation in eligible alternative payment models (APMs)

Medicare Quality Payment Program

The Centers for Medicare and Medicaid Services (CMS) established the Quality Payment Program (QPP) as a model of funding to reward clinicians who provide high-quality patient-centered care. According to CMS, QPP aims to improve the quality and safety of care for all individuals and to reduce the administrative burden on clinicians, allowing more time to focus on person-centered care and improving health outcomes.

The Quality Payment Program has two tracks: MIPs and APMs.

The Merit-based Incentive Payment System (MIPS)
There are 3 MIPS reporting options available to MIPS eligible clinicians to meet MIPS reporting requirements:

• Traditional MIPS
• Alternative Payment Model (APM) Performance Pathway (APP)
• MIPS Value Pathways (MVPs)

Advanced Alternative Payment Models (APMS)
An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. There are multiple types of APMs and you can find more information about these described on CMS’s APMs Overview.

The links below provide additional tools and resources about the Quality Payment Program.

• QPP Resource Library
• CMS Quality Payment Program Webinar Library
• CMS MACRA webpage
• CMS Training Videos