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Understanding MACRA and the Quality Payment Program

Resources to help you prepare your practice and stay informed

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law in April 2015, represents a shift toward value-based care. MACRA permanently repeals the Sustainable Growth Rate (SGR) formula, changing the way Medicare rewards clinicians for value over volume. The new Quality Payment Program (QPP) streamlines several overlapping quality programs under the Merit-based Incentive Payment System (MIPS) and provides bonus payments for participation in eligible Alternative Payment Models (APMs).

PV Podium is here to help you understand how these changes will impact your practice and provide clarity on options and action steps. As QPP evolves, we’ll keep you updated with news and resources so that you can focus on providing the best possible care to your patients.

 

Eligible clinicians select one of two paths within the QPP

   

MIPS consolidates current programs into four performance categories. Providers choose the activities and measures with Quality, Improvement Activities and Advancing Care Information

MIPS graphic
MIPS Measure graphic
  

2019 performance and reporting will be used to adjust 2021 payment

Timeline graphic

In 2019, a MIPS final score of 30 points avoids a negative payment adjustment, and 75 earns an exceptional performance bonus for 2021.

  
MIPS Eligibility
  

APMs

APMs are a payment approach that gives incentive payments to provide high-quality and cost-efficient care. They can apply to a specific clinical condition, care episode, or population.

Advanced APMs are a subset of APMs that let practices earn more for taking on some risk related to their patient’s outcomes. Advanced APM participants who receive 25% of their Medicare Part B payments through an Advanced APM or see 20% of their Medicare patients through an Advanced APM will be exempt from MIPS.

View currently eligible advanced APMs
  

Resources

All MACRA and Quality Payment Program Resources (-)

  • CMS Quality Payment Program Overview

    External Link( 40.0 KB )

    Find comprehensive information on this Centers for Medicare & Medicaid Services website.

  • Glossary of Terms

    External Link( 27.0 KB )

    This American Medical Association article explains Medicare terms.

  • Interactive Assessment Tool

    External Link( 29.0 KB )

    Take the American Medical Association’s MACRA assessment and learn how changes affect your practice.

  • QPP Improvement Areas

    External Link( 29.0 KB )

    View a list and descriptions of available improvement areas, including care coordination, beneficiary engagement, and patient safety.

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