QPP, MIPS and APMs: What Are They & Why Are They Important?
What is the Quality Payment Program (QPP)?
The Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) was signed into law with bipartisan support on April 16, 2015 and went into effect on January 1, 2017. The law does many things but most importantly it establishes a new payment methodology based on how clinicians and groups of clinicians care for Medicare beneficiaries. It is comprehensive legislation that has significantly restructured U.S. healthcare.
The QPP replaces the Sustainable Growth Rate (SGR) Formula that formerly determined Medicare Part B reimbursement rates. Reimbursement under the QPP how hinges on patient care value and outcomes.
There are two paths to participation that focus on incentive’s for care quality rather than volume.
What is the Merit-Based Incentive Payment System (MIPS)?
The MIPS is a pathway that consolidates the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBM) and the Medicare Electronic Health Record (EHR) Incentive Program into one single program. “MIPS was designed to tie payments to quality and cost efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.”¹
Check your MIPS eligibility HERE.
What are Alternative Payment Models (APMs)?
APMs offer a collaborative way to manage Medicare Part B beneficiaries, receive payment for services and earn incentives for providing high-quality, cost-efficient care as a whole. It also requires an application process and acceptance of risk.