Media Issue Brief: Quality Payment Program

How QPP is Transforming Oncology Practice Reimbursement
May 30, 2018
U.S. Medicare Quality Payment Program (QPP)

Figure 1: Medicare Quality Payment Program

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Issue Overview

In 2017, providers and practices across the country began to implement the Quality Payment Program (QPP). Established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), QPP is changing the way physicians are reimbursed for services provided under Medicare Part B. The program aims to incentivize high-quality, high-value care, not high-volume care, under the traditional fee-for-service Medicare physician reimbursement system. 

There are two tracks under QPP: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). MIPS is a performance-based system that gives clinicians the flexibility to choose the activities and measurements that are most meaningful to their practices. MIPS scores are comprised of measurements in four performance categories: quality, cost, improvement activities, and promoting interoperability. Clinicians earn performance-based payment adjustments—positive, neutral, or negative—based on their composite MIPS scores.

Advanced APMs are a subset of Alternative Payment Models (APMs) that typically offer practices greater financial rewards for assuming greater financial risk. APMs are customized payment approaches that give added incentive payments to clinicians or practices that are providing high-quality, high value-care. APMs can focus on specific clinical conditions, care episodes, or populations. What distinguishes APM participation from Advanced APM participation, is that QPP provides added financial incentives for sufficient Advanced APM participation, and Advanced APM participants are allowed to opt out of MIPS.

What’s New in 2018

The second year of QPP began on Jan. 1, 2018. This year, oncology practices face more robust quality reporting requirements to successfully participate in QPP and avoid a financial penalty in 2020.

ASCO has prepared a “Top 10 List for Quality Payment Program Participation in 2018.” The list offers step-by-step guidance for successfully navigating 2018 program requirements, which require practices to report on at least 60 percent of eligible patients for at least six quality measures, versus the minimal “one patient, one measure, no penalties” threshold in 2017. By 2020, it is expected that QPP will be fully implemented throughout the United States.

ASCO has developed its own payment model designed to improve the quality and affordability of cancer care. The model will allow oncology practices to successfully navigate the transforming healthcare environment and transition to alternative payment models. ASCO is currently enhancing the model, “Patient-Centered Oncology Payment” (PCOP), for submission to CMS for consideration as a Medicare APM. ASCO desires to establish PCOP as a viable alternative payment model, which ensures that the full range of services needed by patients with cancer is supported within a value-based reimbursement system that increases patient satisfaction and decreases costs. The PCOP model is currently piloted with a commercial payor.

Key Data Points

  • 30% of Medicare payments tied to alternative payment models (APMs) in 2016.1
  • 43% of physicians are already receiving some portion of their reimbursement under value-based systems.2

"Quality Payment Program: Preparing for 2018, Surviving in 2017." American Society of Clinical Oncology. Accessed May 2018.