Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015, which repealed the Sustainable Growth Rate (SGR) formula used to determine Medicare physician fee-for-service payments.
In SGR’s place, MACRA requires physicians to choose between two major payment tracks: the fee-for-service Merit-Based Incentive Payment System (MIPS), and advanced alternative payment models (APMs). To enable this, the Centers for Medicare & Medicaid Services (CMS) created the Quality Payment Program (QPP) to implement the two tracks for eligible physicians and other clinicians.
The QPP is an annual program that affects Medicare payment two years later. The objective of the program is to incentivize physicians to improve care; reduce costs; and advance health care information among physicians, allied providers, and patients. The third QPP performance year spans Jan. 1 - Dec. 31, 2019.
Under the QPP, physicians in MIPS are paid fee-for-service with payment adjustments (incentives or penalties) two years after each performance year. Payment adjustments will vary depending on individual or group performance in four MIPS categories: quality, cost, improvement activities, and promoting interoperability. The payment adjustment in 2021 will be +/-7 percent based on your MIPS score in 2019.
Physicians who take part in an advanced APM in 2019 are exempt from MIPS and may earn a 5-percent incentive payment for participating in an innovative payment model, in addition to APM-specific rewards.