CMS Quality Programs
The Quality Payment Program (QPP) replaces prior Medicare Quality programs as of January 1, 2017. Enacted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and encompasses two payment pathways (i.e. MIPS
as well as Alternative Payment Models). Visit ASGE's MACRA Resource Implementation Center for more information.
The Physician Quality Reporting System (PQRS) is a quality reporting program that rewards eligible professionals (EPs) for practicing high quality care. Quality is measured by successfully reporting on clinical measures.
The value based payment modifier is mandated under the Affordable Care Act, and requires Medicare to differentiate physician payment based on quality of care compared to cost. The value modifier will be based on PQRS participation.
The Electronic Health Records (EHR) Incentive Programs were designed to reward providers for demonstrating meaningful use of certified EHR technology. To qualify for incentive payments, EPs must meet meaningful use criteria determined by each stage of the program. Starting in 2015, EPs that do not demonstrate meaningful use annually will be faced with a payment reduction in Medicare Part B reimbursement.
The Physician Compare website allows patients to find and choose a physician enrolled in Medicare. The website lists physician details including: practice addresses, specialties, Medicare assignment status, quality program participation, gender, medical school, and residency, associated groups and hospital affiliation. By 2016, Physician Compare will also detail individual physician PQRS and Meaningful Use participation.
The ASCQR program promotes higher quality care by requiring Medicare-certified ASCs to report on quality measures in order to avoid future Medicare reductions. ASCs who do not meet reporting requirements may be subject to a 2% payment reduction to an annual increase of the ASC payment system.