Quality Payment Program

Prior to the launch of the Quality Payment Program (QPP) on January 1, 2017, payment increases for Medicare services were set by the Sustainable Growth Rate (SGR) law. This capped spending increases according to the growth in the Medicare population, and a modest allowance for inflation. However, as clinicians increased their utilization of services, the reimbursement for each unit of service had to be adjusted downward to hold costs constant. In practice, the SGR would have resulted in large decreases in the Physician Fee Schedule, which wasn't sustainable. To avoid these decreases in reimbursement, Congress had to pass a new law (every year) authorizing the current fee schedule and a small increase for inflation. With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS discontinued the use of the SGR as a basis for clinician payments. QPP gave CMS the ability to reward high-value, high-quality Medicare clinicians with payment increases – while at the same time reducing payments to those clinicians who weren’t meeting performance standards. The program establishes a model of funding that rewards clinicians who provide high-quality patient-centered care. QPP aims to improve the quality and safety of care for all individuals and to reduce the administrative burden on clinicians, allowing more time to focus on person-centered care and improving health outcomes. **Objectives of the Program** Over 100,000 physicians and other stakeholders attended our outreach sessions. You’ve given us more than 4000 comments. From this process and your input, we’ve arrived at the following program objectives: - To improve beneficiary population health - To improve the care received by Medicare beneficiaries - To lower costs to the Medicare program through improvement of care and health - To advance the use of healthcare information between allied providers and patients - To educate, engage and empower patients as members of their care team - To maximize QPP participation with a flexible and transparent design, and easy to use program tools - To maximize QPP participation through education, outreach and support tailored to the needs of practices, especially those that are small, rural and in underserved areas - To expand Alternative Payment Model participation - To provide accurate, timely, and actionable performance data to clinicians, patients and other stakeholders - To continuously improve QPP, based on participant feedback and collaboration