The Quality Payment Program/ MACRA

The Quality Payment Program also referred to as The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is bipartisan federal legislation signed into law on April 16, 2015. MACRA repeals the Sustainable Growth Rate (SGR) Formula that has determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care.

Under the Quality Payment Program, participating providers will be paid based on the quality and effectiveness of the care they provide. A large percentage of the physician payment will be based on value – not on volume – like the current fee-for-service system, which is more transactional. High value care commonly referred to as value-based care will be defined by measures of quality and efficiency and providers will be incentivized or decremented based on their performance against those measures.

Physicians will be paid largely based on the outcomes of their care. To pay for value, it must be defined with indicators or measures of care to be selected to evaluate performance. These measures, once selected, will be used to determine increasing percentages of Medicare payment. CMS believes that the Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier.

Medicare states that the Quality Payment Program will reform Medicare payments for more than 600,000 clinicians across the country, and is a major step forward in improving healthcare across the entire country. Providers can choose how they would like to participate in the Quality Payment Program based on their practice size, specialty, location, or patient population.

The Quality Payment Program has two tracks you can choose from:

Advanced Alternative Payment Models (APMs)

If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model.


The Merit-based Incentive Payment System (MIPS)

If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS.

What you do in 2017 will impact what you get paid in 2019.

The proposed first reporting period for MIPS begins January 1, 2017, which currently would apply to

more than 90%

of eligible clinicians in the first year of the program.

Advanced APM

  • Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)(12 participants)
  • Comprehensive Primary Care Plus (CPC+)(available 2017)
  • Medicare Shared Savings Program – (Track 2 & 3)(18 participants)
  • Next Generation ACO (18 participants)
  • Oncology Care Model Two-Sided Risk Arrangement (available 2018)


  • Physicians
  • PAs
  • NPs
  • Clinical nurse specialists
  • CRNs
  • Anesthetists
  • Groups that include such clinicians

Quality Payment Program Participants

You are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $30,000 to Medicare, and provide care to more than 100 Medicare partients per year, and you are one of the following:


Physician Assistant

Nurse Practitioner

Clinical Nurse Specialist

Certified Registered Nurse Anesthetist

If 2017 is your first year participating in Medicare, then you are not required to participate in the Quality Payment Program in 2017.

Contact Us Today to Learn How We Can Successfully Assist You in Participating in the Quality Payment Program (QPP)