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MACRA and the Quality Payment Program

 

MACRA and the Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015, and became final in October 2016. 

The MACRA law eliminated the sustainable growth rate (SGR) formula that had previously been used to calculate Medicare payments to physicians and had resulted in repeated threats of severe payment cuts. The law provides a more predictable Medicare payment schedule for physicians and other clinicians, while moving the payment system away from a volume-based system toward a system that rewards value. This new payment system is called the Quality Payment Program (QPP).

Read how ACP advocated on behalf of clinicians and influenced the MACRA 2017 Final Rule:

MORE ACP ADVOCACY ON MACRA

Let ACP guide you through QPP

 

Quality Payment Advisor

Take advantage of ACP's Quality Payment Advisor® (QPA), a free online tool for ACP members that will indicate if you need to participate in the Quality Payment Program and what track you should be in. The QPA also identifies performance gaps and details specific actions to take to position your practice for success under the QPP.

 

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What is the Quality Payment Program?

The Quality Payment Program (QPP) is the name for the Medicare Part B physician payment system that was established by the MACRA law. Starting in 2017, physicians will begin participating in one of two payment tracks to earn additional increases in their Medicare payments in 2019—the Merit-Based Incentive Payment System or an Alternative Payment Model. Physicians, or their practices, will have the opportunity to decide annually the program in which they will be participating.

Do you qualify for QPP?Download brochure


Learn about the QPP payment tracks

 

MIPS

Merit-Based Incentive Payment System

The Merit-Based Incentive Payment System (MIPS) builds on traditional fee-for-service payments by adjusting them up or down based on a physician’s performance in a new reporting system. Learn more

APMs

Alternative Payment Models

Alternative Payment Models (APMs) are a new approach to paying for medical care that incentivizes quality and value. Some APMs will qualify as “Advanced APMs." Learn more


Transition at the pace that suits you!

In 2017, CMS is allowing Eligible Clinicians (EC) to “pick their pace” by creating different levels of participation to allow flexibility during the transition year. If an EC is not in any type of APM arrangement, during 2017 there are three paths to participation in MIPS.

Note: During 2017, the transition year, there will be no negative adjustments as long as one of the above options is chosen. However, practices are encouraged to participate to the fullest extent possible to prepare for participation in 2018 and onward.


Latest information on QPP


Have more questions?

MACRA and the resulting Quality Payment Program are very comprehensive, and oftentimes confusing topics that affect all types of clinicians participating in Medicare Part B. If you still have questions or need further guidance, try these resources.

For more information or questions or concerns regarding specific MACRA-related issues, email macra@acponline.org.

We also encourage you to discuss MACRA with your colleagues in the Member Forum on MACRA.

Quality Payment Program (QPP)

Finalized in October 2016, the Quality Payment Program (QPP) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), officially replacing the old Sustainable Growth Rate system. The new QPP transforms Medicare physician compensation, moving away from fee-for-service billing and toward payment based on value.

Understanding QPP is crucial for clinicians who participate in Medicare Part B. The below chart will help you determine if you quality for QPP.

Do you qualify?

YES
NO
Medicare Part B payments
Medicare Part A (e.g., hospital payments)
Physicians, PAs, NPs, CNSs, and CRNAs
Clinicians that fall below the low-volume threshold*
Groups that include the above clinicians
Clinicians billing Medicare for the first year (for MIPS)

*If you bill Medicare less than or equal to $30,000 a year OR provide care for less than or equal to 100 Medicare patients a year.

If you do qualify to participate in QPP, you will need to decide which payment track to follow - the Merit-based Incentive Payment System or an Alternative Payment Model.

Pick Your Pace: Full Participation

Participate fully as an individual or in a group and receive a payment adjustment in 2019 based on performance for at least 90 consecutive days or, ideally, for the entire year. The 90-day period can be the same or different for the performance categories. Full participants will be eligible to earn a positive adjustment. Positive adjustments will be based on the performance score of data submitted, not the amount or length of time submitted. However, longer performance periods may yield better results due to a larger pool of patients in the sample for certain quality measures.

Pick Your Pace: Partial Participation

Submit individually or in a group for at least 90 days but less than a full year on a limited set of measures: more than one quality measure, or attestation to more than one improvement activity, or report on all five base measures plus at least one additional performance measure in the Advancing Care Information category. Partial participation may result in neutral or positive adjust.

Pick Your Pace: Test

Submit a single Quality measure, or attest to a single Improvement Activity, or submit the 4 or 5 (dependent on edition of Certified EHR Technology) required base measures from the Advancing Care Information Category in 2017. This option does not earn any positive adjustments in 2019 – payment will remain neutral. There is no requirement regarding participation for any length of time. This option is intended to allow ECs the chance to experiment with the new program.