What is QPP? How are APMs and MIPS linked to QPP?

In healthcare, we use a lot of acronyms and numbers – QPP, APMs and MIPS are no exception. 

So what is QPP? The Quality Payment Program (QPP) improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, and replaced it with QPP. If you participate in Medicare Part B, the QPP will provide new tools and resources to help you give your patients the best possible care.

How are APMs and MIPS linked to QPP? Well, the Quality Payment Program has two tracks:

Advanced Alternative Payment Models (APMs): If you receive 25% of Medicare payments or see 20% of your Medicare patients through an Advanced APM in 2017, then you earn a 5% incentive payment in 2019.

The Merit-based Incentive Payment System (MIPS): If you decide to participate in MIPS, you earn a payment adjustment based on evidence-based and practice-specific quality data. Based on your participation in 2017, called Pick Your Pace, you may see no financial adjustment or a positive financial adjustment up to a maximum  of 4% to your Medicare payments for covered professional services that will be applied in 2019 for Medicare Part B payments made in 2017.

If you don’t participate in either APMs or MIPS, then you will receive a negative 4% payment adjustment.