What is it?
The Quality Payment Program is a CMS pay-for-performance program that affects Medicare Part B professional services reimbursement. There are two payment tracks under the QPP:
- Advanced Alternative Payment Models (APMs): Only clinicians who take on significant downside financial risk in Advanced APMs are eligible. Participants in the APM track earn incentives such as a 5% bonus in the first six years of the program and do not need to report performance data under the QPP.
- Merit-Based Incentive Payment System (MIPS): Participants are evaluated on performance across four categories: quality, cost, improvement activities for care delivery, and promoting interoperability through electronic health record (EHR) use. Participants earn incentives or penalties based on their overall performance. Most clinicians in the QPP participate in the MIPS track.
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) set annual baseline payment updates for clinicians and established the QPP. The first performance year began on January 1, 2017. Performance affects payment two years later, so 2019 was the first year clinicians began to see payment adjustments. CMS will continue to evolve the QPP through annual updates in the Medicare Physician Fee Schedule (MPFS) regulations.
The QPP applies to clinicians who bill Medicare Part B and meet the eligibility criteria established by CMS, regardless of clinical setting. Examples of eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists (the list of eligible clinicians also includes physical therapists, occupational therapists, clinical psychologists, speech language pathologists, audiologists, and registered dietitians or nutrition professionals).