The Quality Payment Program (QPP) is an incentive program for healthcare providers implemented by the Centers for Medicare & Medicaid Services (CMS). The QPP rewards value and outcomes, in a move toward value-based care, through two separate programs: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). The healthcare provider’s performance is measured in terms of Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost.
To be eligible for the MIPS program, the healthcare provider must meet the low volume threshold set by CMS, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule. The initial goal for CMS was to have 90% of healthcare professionals eligible for MIPS submit their data in 2017.
The preliminary results show that CMS has met their goal, plus a little more. The numbers show that 91% of those healthcare providers eligible for MIPS submitted their data successfully in 2017. Accountable Care Organizations (ACOs) showed even more impressive numbers with 98% submitting data in 2017. Additionally, 94% of small and rural healthcare practices submitted MIPS data successfully in 2017.
Most independent physicians probably did not see significant incentive payments, however. The MIPS structure is such that incentives are paid out from the penalties collected. In 2017, healthcare providers who submitted any data were able to avoid the penalties, to encourage participation.
Of those who submitted their data successfully in 2017, many providers will see neutral or minimally positive payment adjustments. The exception will be for those healthcare providers who achieved exceptional performance based on the scoring metrics. Those payments are made from an existing $500 million incentive pool.
The official CMS report on final MIPS scores was scheduled to be published in the summer of 2018.