The Quality Payment Program (QPP) aims to tie together disparate programs incentivizing and penalizing healthcare providers to reduce costs while improving access and quality. Under QPP, providers can choose between Advanced APMs, which offer incentives for participating in innovative payment models, or MIPS, where providers earn performance-based payment adjustments through traditional Medicare. QPP applies to physicians, PAs, nurse practitioners, and others billing over $30,000 annually to Medicare and seeing over 100 Medicare patients. Providers must report 2017 data by March 31, 2018 and may begin earning positive 2019 payment adjustments based on their 2017 performance. QPP evaluates providers on four categories: Quality, Advancing Care Information, Improvement Activities, and

1. Annals of QPP
The Annals of QPP

2. Annals of QPP 2
Introduction
With the healthcare spending increasingly burgeoning,
the US government has been planning to introduce
ways to cut it down while increasing access and reduc-
ing expenses.
In the past, many programs were introduced to incen-
tivize/penalize providers in order to drive them to-
wards these goals. As the number of these programs
increased, it became difficult for providers to under-
stand what’s relevant to them. So, now Quality Pay-
ment Program (QPP) aims to tie these disparate pro-
grams together and achieve something bigger than
other programs
There are 2 tracks to choose from:
 Advanced Alternative Payment Models (APMs) –
Under this, through Medicare Part B you may earn
an incentive payment for participating in an inno-
vative payment model.
 The Merit-based Incentive Payment System
(MIPS) - If you decide to participate in traditional
Medicare Part B, then you will participate in MIPS
where you earn a performance-based payment ad-
justment.
Do I need to worry?
QPP is applicable to all Physicians, Physician Assis-
tants (PAs), Nurse practitioner, Clinical nurse spe-
cialist and Certified registered nurse anesthetist who
bill Medicare > $30000 annually and who provide
care to more than 100 Medicare patients.
Fig 1: Applicability of QPP
And by when?
Newbies starting with Medicare for the first time in
2017, aren’t under MIPS.
The rest:
 Need to report at least 90 day data (Between Jan 1
to Dec 31st 2017)
 Need to be submit this data by 31st Mar 2018 and
will get feedback
 May earn a positive MIPS payment adjustment
beginning Jan 1st 2019
So what are my options?
Under Advanced APMs
Submit data for the entire year in 2017 and receive a
5% positive adjustment in 2019 if you:
 Receive 25% or more of your payments through
Medicare
 See 20% or more of your Medicare patients
through Advanced APM

3. Annals of QPP 3
Under MIPS
What if I don’t?
The adjustments start with +/-4% in 2019 but go all the way to +/-9%. This means the difference between reporting
or not reporting could be a whopping 18%.
Alright, what do I need to do for it?
QPP has four components as described below. The providers’ performance on different criteria under each of these
will lead to a category score which will be then multiplied with the weightage. The summation of the scores after
applying the weightage will be the composite score. This score becomes the single yardstick to compare provider
performance.
1. Quality – This replaces the PQRS program and has the most weightage in MIPS. In 2017, its 60% but from 2018
it will be 50%.As the impact of this category is substantial enough to pull the overall score down, providers
need to score well on this one. EHR vendors might find providers asking for capabilities broader than what
they had for PQRS. That way, they can report on the criteria where they scored the best.
2. Advancing Care Information (ACI) – This replaces EHR incentive program for providers and will have 25%
weightage in 2017 and 2018. There are several objectives and criteria for those that providers need to score on in
order to achieve a full score.

4. Annals of QPP 4
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About the Author
Vijayalaxmi Kudekar, Healthcare Consultant
Vijaya is a Healthcare Expert at Nalashaa and has experience in business transformation, payer-provider integration,
product design & implementation and healthcare system evaluation & selection. She has been actively involved in
Meaningful Use, PQRS, HHVBP, CPC+, CCM and MACRA implementations and has extensive exposure to Clinical
and Financial areas of the US healthcare ecosystem.
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