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MACRA and the Quality Payment Program

 

Medicare’s Quality Payment Program (QPP)

What's New

COVID-19 Flexibilities In response to ACP advocacy, CMS extended the MIPS extreme and uncontrollable circumstances exception due to COVID-19 through 2021. Applications for the 2021 performance year are due December 31, 2021. Find more information here. CMS separately announced flexibilities for several APMs due to COVID-19. For more information, access this CMS fact sheet.

Final 2021 Medicare Physician Fee Schedule/QPP Final Rule CMS finalized the rule on Dec. 1, 2020. Read ACP’s detailed analysis of the final rule.

 


 

MIPS

Merit-Based Incentive Payment System

Under the Merit-Based Incentive Payment System (MIPS), eligible clinicians continue to be paid on a fee-for-service basis and report cost and quality data. Following each performance year, clinicians are evaluated on their performance relative to other clinicians in the country and receive a positive, neutral, or negative payment adjustment to their Medicare Part B payments in a future payment year.  Learn more

APMs

Alternative Payment Models

Alternatively, clinicians can choose to participate in one or more of the available Alternative Payment Model (APMs). APMs vary in design, but all aim to restructure payments in a way that financially incentivize low-cost, high-value care. In addition to any model-specific payments they receive, clinicians who significantly participate in models that meet certain requirements for advanced technology, quality, and financial risk capabilities are excluded from participating in MIPS and can earn a 5% Medicare bonus. Learn more


Other Value-Based Payment Reform Efforts

Medicaid, Medicare Advantage, and private payers have increasingly been developing their own quality performance programs and APMs. To the right is the breakdown of value-based payments for commercial, Medicaid Advantage, and Medicaid payers, based on 2019 data.

Source: Health Care Payment Learning & Action Network

 


Advocacy Efforts from ACP

Learn about ACP’s latest advocacy efforts to reform and improve the Quality Payment Program. Learn more


Have more questions?

Email reg-affairs@acponline.org

Visit the official QPP website

Join ACP's MACRA Member Forum