Quality Payment Program—basic breakdown of MACRA
| MIPS | AAPM | |
|---|---|---|
| Definition | Merit-Based Incentive Payment System | Advanced Alternative Payment Model |
| Payment adjustment components | Quality (replaces PQRS) | Quality measures like MIPS |
| Advancing care information required (eg, use of EMR) | ||
| Implementing CPIAs is required | Otherwise, varies on the basis of APM model (eg, BPCI, Next Generation Accountable Care Organization Model, and so forth) | |
| Measures of cost | ||
| Basic inclusion requirements | Fail 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/penalties | Upward or downward adjustment of 4%, based on performance measured in 2017 | QPs not subject to budget-neutral payment/adjustment |
| Percentage adjustment increases each year, reaching a maximum of ±9% in 2022 | Automatic 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 year | Beginning 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) | 2019 | 2019 |
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.