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QPP 2017

The QPP or the Quality Payment Program 2017

The Department of Health and Human Services (HHS) implemented the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through issuance of its final rule on October 14, 2016. MACRA ends the Sustainable Growth Rate formula.

The Quality Payment Program will reform Medicare payments for more than 600,000 clinicians across the country – and will play a pivotal role in monitoring, and improving the quality of care provided across the entire healthcare delivery system.

The quality payment program provides choice between two tracks:

The QPP focuses on rewarding, patient centric, high value clinical care. The last possible reporting period for the QPP is October 2nd 2017 to December 31st 2017.

MIPS or the Merit Based Incentive Payment System

Eligibility Criteria:

You must bill more than $30,000 to Medicare, and provide care to more than 100 Medicare patients (per year) and – you must be a:

  • Physician
  • Physician Assistant
  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist

*If 2017 is your first year participating with Medicare you are not eligible to participate in MIPS.

For a thorough eligibility check please click here

The MIPS Pathways

MIPS under MACRA eliminates the all-or-nothing approach of the legacy Quality programs (PQRS, VM, MU) and replaces the concept with a flexible “pay for performance” method.

The MIPS Breakdown

Additional Information

Reputational Impacts

CMS publishes sets of clinician-identifiable performance measures through the Physician Compare website for consumers to browse and third-party physician rating websites to acquire for free. With a more digitally aware consumer population, this data will be readily available for patients to view.

Group vs. Individual participation

The MACRA final rule also provides option between individual and group participation. Many providers exempt individually, may be eligible to report with a group.

P3 – Optimizing Your Performance

With long running experience on Medicare Part B Quality Reporting, seasoned P3 analysts and consultants provide more than just a helping hand. We take control of your demonstration from day one, and make sure staff time, and physician time is saved through-out the program’s demonstration.

Currently P3 is executing services for more than 200 physicians spread across all specializations!

Participation with Advanced APMs

Eligibility Criteria:

You must receive 25% of Medicare covered professional services;


See 20% of your Medicare patients through an Advanced APM in 2017, to be eligible for this track – and to be exempt from MIPS.

Being eligible with an Advanced APM means you may earn an incentive payment of up to 5% - while you take financial risk based on patients’ outcomes.

For PY 2017 the following models are regarded as Advanced APMs:

  • Comprehensive ESRD Care Model (LDO arrangement)
  • Comprehensive ESRD Care Model (non-LDO arrangement)
  • CPC+
  • Medicare Shared Savings Program ACOs— Track 2
  • Medicare Shared Savings Program ACOs— Track 3
  • Next Generation ACO Model Oncology Care Model OCM (two-sided risk arrangement)

For a thorough eligibility check please Click Here

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