What is QPP?

Overview of the Quality Payment Program

Simply put, the Quality Payment Program (QPP) is the United States Department of Health and Human Services' (HHS) take on further transitioning the healthcare industry from fee-for-service to value-based care (volume to value).

On October 14, 2016, HHS issued its final rule with a comment period implementing QPP as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). QPP improves Medicare by directing the focus to care quality and the one thing that matters most - making patients healthier. MACRA ended the sustainable growth rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. QPP's purpose is to provide tools and resources to give patients the best possible, highest value care.

As was the case last year, there are two QPP tracks to choose from for 2019:


Alpha II is a CMS-Approved Qualified Registry for MIPS Reporting for 2019

What is MIPS?

MIPS consolidates three previous programs (Physician Quality Reporting System (PQRS), meaningful use, and Value-Based Modifier) into one program and focuses on four categories of clinical care. Providers are assigned a composite score based on their performance across all four categories, which serves as a modifier to their Medicare Part B reimbursements.

Under MIPS, payment adjustments are earned based on evidence-based and practice-specific quality data. Based on your performance in 2019, you will see a positive, neutral, or negative adjustment of up to seven percent of your Medicare payments for covered professional services furnished in 2021.

What are APMs?

An Alternative Payment Model (APM) is another payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

If you decide to participate in traditional Medicare rather than an APM, then you will participate in MIPS where you earn a performance-based payment adjustment to your Medicare payment.

Alpha II has selected to focus only on MIPS reporting since the majority of our partner clinicians will report under MIPS.

The Four Performance Categories Under MIPS

Performance Categories

Who is eligible for MIPS?

You are eligible to participate in the MIPS track of QPP if you bill more than $90,000 to Medicare, give care to more than 200 Medicare patients per year, provide more than 200 professional services under Physician Fee Schedule (PFS), and are one of the following:

Who is in the Quality Payment Program?

What is the 2019 MIPS timeline?

MIPS Submission Timeline

What resources are available to help select quality measures?

You will need to submit six individual measures (from the 257 available) including at least one outcome measure. If an outcome measure is not available for your specialty, then choose at least one high-priority measure.

Specialty-specific measure set: Not all measures in each specialty measure set will be applicable to all clinicians in a given specialty. If the set includes fewer than six applicable measures, the eligible clinician need only report the measures that are applicable.

High-priority measure set: High-priority measures include outcome, appropriate use, patient experience, patient safety, efficiency, and care coordination.

Information about specialty-specific and high-priority measures is available on our online MIPS Measures page.

For more information about QPP, click here.