CMS Quality Payment Program

Established under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), CMS’ Quality Payment Program (QPP) will shift Medicare payments away from fee-for-service towards a value-based system.

The law establishes two tracks: The Merit-based Incentive Payment System (MIPS) and APM (Advanced Alternative Payment Models). The majority of clinicians will operate under MIPS. This track streamlines three currently independent programs and adds a fourth component. Under MIPS, Medicare payments will be modified according to performance in the following categories:

  • Quality
  • Resource use
  • Practice Improvement
  • Advancing care information

Clinicians will be choosing the measures and activities that are most meaningful to their practice to demonstrate performance. Based on performance, beginning in 2019, clinicians will receive positive or negative adjustments of the payments from 4 % (in 2019) to 9 % (in 2022). 2017 will be the performance year that determines payment adjustments for 2019, so practice transformation needs to begin now.

During 2017, eligible physicians and other clinicians will be able to pick their pace and have the option of multiple ways to participate in the new quality payment program.  These include:

  • Testing the Quality Payment Program
  • Participating for part of the calendar year
  • Participating for the full calendar year
  • Participating in an Advanced Alternative Payment Model in 2017

For more details about these options, please read “The CMS Blog”.

Given these challenges and options, the Transforming Clinical Practices Initiative (TCPi) is the Center for Medicare and Medicaid Services’ (CMS) tool to help practices get a head start in preparing for the new payment environment. Under the proposed ruling for QPP, practices will get credit for practice improvement activities undertaken as part of TCPi participation.

You can read more about QPP at https://go.cms.gov/QualityPaymentProgram. We particularly recommend taking a look at this brief overview.