Table 2:

Quality Payment Program—basic breakdown of MACRA

DefinitionMerit-Based Incentive Payment SystemAdvanced Alternative Payment Model
Payment adjustment componentsQuality (replaces PQRS)Quality measures like MIPS
Advancing care information required (eg, use of EMR)
Implementing CPIAs is requiredOtherwise, varies on the basis of APM model (eg, BPCI, Next Generation Accountable Care Organization Model, and so forth)
Measures of cost
Basic inclusion requirementsFail to meet the 3 requirements to be in an AAPM (see cell to the right)Use of approved EMR
Base reimbursement on quality measures like MIPS
Required to bear “more than nominal” financial risk
Benefits/penaltiesUpward or downward adjustment of 4%, based on performance measured in 2017QPs not subject to budget-neutral payment/adjustment
Percentage adjustment increases each year, reaching a maximum of ±9% in 2022Automatic 5% bonus payment based on aggregate Medicare Part B payments during the first 6 years
Increase in fee schedule conversion factor used to calculate Medicare Part B payments of 0.25% per yearBeginning in 2026, 3-fold increase for QPs in their fee schedule conversion factor used to calculate Medicare Part B payment of 0.75% per year for QPs
Effective date (begins impacting physicians' Medicare Part B reimbursements)20192019
  • Note:—AAPM indicates Advanced Alternate Payment Model; BPCI, Bundled Payments for Care Improvement Initiative; EMR, electronic medical record; CPIA, Clinical Practice Improvement Activities; QP, Qualifying Participant.