What Is the Medicare Quality Payment Program?

What Is the Medicare Quality Payment Program?



The healthcare environment is complex and constantly changing, even more so when a new administration takes over. Even under new leadership, one area that has remained constant is the adoption of value-based care and payment models, including MACRA and the Quality Payment Program.
When it comes to the QPP, 2017 will be the year to get “your feet wet” and see what changes you and your practice need to make to maximize your reimbursements. Even though the Center for Medicare and Medicaid Services only requires providers to submit data on only one measure, we recommend submitting more than one measure so you get a better idea of what to expect in 2018. It’s important to start planning for 2018 and how you’ll maximize your revenue while transitioning to a value-based care system.



Quality Payment Program


The Quality Payment Program is under MACRA, the Medicare Access and CHIP Reauthorization Act, which replaces the fee-for-service payment system and the Sustainable Growth Rate (SGR). There are two tracks available under the QPP: MIPS, or Merit-based Incentive Payment System; and APMs, or Alternative Payment Models.


What is the Merit-based Incentive Payment System?


MIPS is the right track for you if you’re a Medicare Part B clinician, billing more than $30,000 AND providing care for more than 100 Medicare patients a year. Eligible clinicians include:

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists


Clinicians enrolling for the first time with Medicare are exempt from reporting on measures and activities for MIPS. There is also an exception for small, rural providers that see less than 100 Medicare patients or receive less than $30,000 in payments from Medicare. For more information about the small, rural practices, click here.

Clinicians under MIPS can choose their own pace:


How Does MIPS Work?


Providers that choose to participate in MIPS will receive a performance-based payment adjustment to their Medicare payments. The four reporting categories included in MIPS are:

  1. Quality – Replaces PQRS
  2. Improvement Activities – A new category including care coordination, patient engagement and safety. To view list of activities, click here.
  3. Advancing Care Information – Replaces Meaningful Use
  4. Cost – Replaces the Value-based Modifier. This measure won’t be used when calculating payment adjustments until 2018.


What Is An Alternative Payment Model?


An APM is a partnership with the clinician community that provides incentives to providers of high-quality and cost-efficient care. APMs can focus on a specific clinical condition, a population or a care episode.

An Advanced APM is a subset of APMs, and lets practices earn an additional 5% for taking on some risks related to their patients’ outcomes.
In 2017, the following models quality as Advanced APMs:


Next Steps


You’ve decided to participate in the QPP, but don’t know where to start? These steps will guide you in the right direction:


  1.  Take our quiz to help guide you on the right track: “Which Quality Payment Model Is Right for You?
  2. Make sure your EHR is certified by the Office of the National Coordinator (ONC) for Health Information. To view a list of products, click here.
  3. Decide which data registry you’ll use to submit your data.
  4. Explore the MIPS measures and narrow down which ones apply to your practice and you feel like you’re already excelling at.
  5. Decide whether you’d like to report as an individual or as a group.
  6. Contact us to start your 2018 strategy.


We hope you found this guide helpful, and, as always, let us know if you have any questions by filling out our contact us form, or emailing us directly at APMPlus@shcare.net


  • Vicki perry
    Posted at 18:08h, 25 April Reply

    Thank you and think this is very relevant!

Post A Comment