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Glossary Terms

What is The Quality Payment Program (QPP)?

Glossary

The Quality Payment Program (QPP) was introduced by MACRA in 2015. It introduced two payment tracks that replaced the Sustainable Growth Rate (SGR) law and aimed to improve physician payouts based on the quality of the services they deliver to patients. 

Prior to 2015, the Sustainable Growth Rate (SGR) law determined the size of physician payouts for Medicare services. The problem with SGR is that its structure requires Congress to pass a new law every year to authorize an updated fee schedule that aligns with inflation and the growth of the Medicare population.   

In addition to legislative complexity, the SGR also failed to account for the quality of service physicians delivered. As such, MACRA sought to replace SGR with the Quality Payment Program (QPP), which aims to award physicians that meet certain quality benchmarks while decreasing payments for those who do not. 

Payment Tracks in The Quality Payment Program

The two payment tracks offered under the QPP include the merit-based incentive payment system (MIPS) and the alternative payment model (APM). While MIPS is more common, physicians can decide which payment track to pursue based on their specialty, location, or the size of their practice. 

  • MIPS is the simplest payment track and combines existing initiatives, including the Physician Quality Reporting System and the Value-Based Payment Modifier.
  • APM requires similar reporting requirements to MIPS, but requires physicians to accept greater financial risk at the chance of a larger payout through participation in an ACO. This requires providers to prove that they can deliver greater quality without substantially increasing costs, or if they can decrease costs without negatively impacting quality. 

Because the QPP assigns a score to every physician, even when being scored as a group, it's essential that they are informed about reporting requirements and what they need to do to improve their score. 

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