Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015, which repealed the Sustainable Growth Rate (SGR) formula used to determine Medicare physician fee-for-service payments.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.
To find out if you are eligible and required to participate in MIPS for the 2019 QPP performance year, check the QPP lookup tool. When you review your profile, take note of any designation assigned to you under “other reporting factors” (e.g., small practice, rural practice, health professional shortage area, facility-based) and learn about what these factors mean to your practice. Physicians required to participate in the 2019 QPP must submit data to CMS by April 30, 2020. However, because of COVID-19 you might qualify for an exception that would result in a neutral payment adjustment, meaning neither a MIPS bonus nor a 7% payment penalty in 2021. See details here. If you have questions about your participation status, contact the QPP Service Center at (866) 288-8292, or by email at QPP[at]cms[dot]hhs[dot]gov.
Review the full 2019 QPP timeline and stay on top of MIPS and APM deadlines, snapshots, and milestones.
TMA Practice Consulting offers quality improvement services to help prepare physician practices for MACRA. TMA's practice management consultants can conduct a MACRA readiness assessment of your practice and provide customized on-site assistance to help you with your practice's specific needs.
The Physicians Advocacy Institute, in collaboration with health care consulting firm Healthsperien and TMA, created a MACRA QPP physician education initiative and separate resource center to make the program easier to understand. The website is free, designed for all levels of physician knowledge on the MACRA QPP, and complements TMA’s MACRA Resource Center. Visit the MACRA QPP Resource Center to access free resources and subscribe to the QPP Roundup newsletter.
Learn about MACRA and the QPP and earn CME credits.
Part One: TMA 2019 Quality Payment Program Webinar Free CME
Part Two: TMA 2019 Quality Payment Program Webinar Free CME
CMS 2019 Quality Payment Program Modules Free CME
CMS Quality Payment Program Webinar Library
TMF Quality Payment Program Webinars
Learn about the Quality Payment Program using TMA, American Medical Association, and CMS resources and tools.
Texas Medical Association
Medicare QPP Physician Education Initiative
Alphabet Soup: A MACRA Glossary and Acronym Guide
American Medical Association
Medicare Quality Payment Program
Centers for Medicare & Medicaid Services
Quality Payment Program: Merit-based Incentive Payment System and Alternative Payment Models
Help and Support, Support and Available Options for Small, Underserved, and Rural Practices
QPP Resource Library, QPP Portal, Timeline and Important Deadlines
U.S. Department of Health & Human Services
How to Propose Your Own Physician-Focused Payment Model under MACRA
Get MIPS Credit for Participating in COVID-19 Clinical Trials Texas Medicine Today, April 21, 2020
Apply by April 30 to Avoid a 7% MIPS Payment Penalty Texas Medicine Today, Apr. 20, 2020
CMS Postpones 2019 MIPS Reporting Deadline to April 30 Texas Medicine Today, Mar. 23, 2020
Deadline: Claim Your 5% Medicare Bonus by Feb. 28 Texas Medicine Today, Jan. 21, 2020
An Unfair Game: Quality Payment Program Rules Still Stacked Against Physicians Texas Medicine, Jan. 1, 2020
AMA House Rejects MIPS Plan Texas Medicine Today, Nov. 20, 2019
Read More About MACRA
Explore the list of federally funded initiatives to help you transition to MIPS or APMs. All services are available to physicians and group practices at no or low cost.
CMS Quality Payment Program Help and Support
Quality Payment Program – Small, Underserved, & Rural Support
TMF Quality Payment Program Network
Transforming Clinical Practice Initiative
Health Care Payment Learning and Action Network
The Innovation Center’s Learning Systems
Participate in MACRA activities, propose your own measures and activities, or give feedback.
Sign Up for Feedback Sessions to Improve the QPP Website - Include the subject line: "Yes, I would like to help CMS improve the QPP website"
Participate in Field Testing and Provide Feedback on Cost Measures
Participate in Study on Quality Reporting Burdens and Get MIPS Credit
Propose MIPS Measures and Improvement Activities for Consideration
Participate in Clinical Subcommittees to Develop MACRA Episode-Based Cost Measures
Participate in CMS Measure Development Testing Related to Clinician Referrals
Comment on Physician-Focused Payment Model Proposals
Promoting Interoperability (PI) Resource Center
TMA EHR Adoption Resources
Got MACRA questions, call or email the Knowledge Center
Terminology and Quality Data Requirements
Promoting Interoperability Requirements
Cost Category Requirements
Improvement Activities Requirements
To help you get the best information possible, TMA has identified direct links to MACRA news, resource centers, education, and advocacy from national specialty societies. Visit your specialty society online for information specific to your specialty, setting, and practice.
See our list.
If you are an eligible clinician and you’re experiencing some type of “significant hardship” that has created “overwhelming barriers” to complying with MIPS’ Promoting Interoperability (PI) category, you are eligible to submit a hardship application.
Subscribe to Centers for Medicare & Medicaid Services (CMS) email lists to stay informed of new policies or changes to relevant Medicare programs and for the latest MACRA information. Stay up to date with MACRA deadlines and compliance dates by visiting TMA’s Deadlines for Doctors.
QPP Email Updates
CMS EHR Incentive Program Listserv
Medicare Learning Network National Provider Calls and Events
CMS Open Door Forums