Quality Payment Program and MIPS

The Medicare Accessibility and CHIP Reauthorization Act (MACRA) introduced several changes to the physician reimbursement framework. MACRA replaced the Sustainable Growth Rate formula with the Quality Payment Program (QPP) to provide incentives that emphasize value and quality of care over volume. The QPP is comprised of four performance categories: Quality, Improvement Activities, Cost and Promoting Interoperability.

Under the QPP, clinicians can participate in either the Merit-based Incentive Payment System (MIPS) or in Advanced Alternative Payment Models (APMs) to avoid downward payment adjustments and potentially receive upward adjustments. CMS estimates for the first few performance years a majority of clinicians will follow the MIPS track.

More information on the Quality Payment Program and Advanced Alternative Payment Models »

Read MIPS Overview 

2021 QPP Updates Webinar

MACRA experts Lauren Golding, MD and Rich Heller, MD provide updates and analysis related to the new MIPS participation year.
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Quality Payment Program Year 5

Under the QPP, clinicians can participate in either the Merit-based Incentive Payment System (MIPS) or in Advanced Alternative Payment Models (APMs) in order to avoid downward payment adjustments and potentially receive upward adjustments. Payment adjustment for 2023 payment year (based on 2021 reporting) ranges from -9% to +9%. CMS has approved the ACR National Radiology Data Registry (NRDR) as a Qualified Clinical Data Registry (QCDR) for 2021. Radiology group practices can continue to use the ACR NRDR QCDR to satisfy 2021 MIPS requirements.

CMS anticipates a majority of clinicians will participate in the MIPS track. MIPS allows Medicare clinicians to be paid for providing high-quality, efficient care through success in four performance categories as shown below. Each category is weighted and added into a final MIPS performance score:

  1. Quality (40%): To complete this requirement, radiologists will need to report up to 6 quality measures, including an outcome measure, with 12 months of data. Quality improvement will be calculated based on performance, with up to 10 percentage points available. If there is not sufficiently complete data, 0 percentage points will be given.
  2. Promoting Interoperability (25%): Most ACR members will be reweighted to zero in this category as non-patient-facing clinicians or hospital based eligible clinicians, but data may be submitted if clinicians would like to receive credit. For non-patient-facing clinicians, these 25 percentage points will be reweighted to the quality category.
  3. Improvement Activities (15%): Radiologists will be required to attest completion to up to 4 improvement activities. Small, rural and shortage area practices or non-patient-facing MIPS physicians need two medium-weighted improvement activities or one high-weighted improvement activity to meet full performance score. 
  4. Cost (20%): The cost category will measure Medicare Spending per Beneficiary (MSPB) and Total Per Capita Cost (TPCC). Cost will be calculated using claims and will not require data submission. 

Highlights of QPP Year 5:

  • Minimum of 12 months performance period for the Quality category.
  • The performance threshold has been raised from 45 points to 60 points.
  • A MIPS score of 60 avoids negative adjustment; a score of 85+ earns the exceptional performance bonus.
  • Practices who plan to submit Improvement Activities as a group must now attest that at least 50% of the group participated in the submitted activities.
  • No changes to the policies for small and rural or non-patient facing practices.
  • Minor changes to category weights; Quality has been lowered to 40% and Cost raised to 20%.

For more details please view the ACR summary of the QPP Final Rule impact on Radiology and the CMS Quality Payment Year 2 Fact Sheet.

Quality Measures Most Relevant to Radiology

Diagnostic

Interventional

Radiation Oncology

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