The Quality Payment Program, also referred to as the QPP, is a program implemented by the Department of Health and Human Services through the Centers for Medicare and Medicaid Services (CMS). In brief, the QPP is a reimbursement mechanism that is designed to place a high value, and hence reimbursement, on physicians that are delivering high-quality care, while separating these from physicians who are not meeting national or specific standards of quality of care. The QPP is a program in multiple parts, including data collection, summarization, feedback generation, and finally, calculation of payment[1]. Not only is the QPP a means of ascertaining the financial reimbursement for physicians serving Medicare-insured populations, but also, it is a mechanism by which physicians can be included in the decision-making process. Launched in 2017, the QPP is currently now in its second year of program participation across the United States, with preliminary results promising.
Before a discussion of the current state of the QPP, it is important to understand how exactly the program functions. To participate in the program, physician practices must agree to meet extensive data collection objectives. In line with this, the QPP urges practices to demonstrate how technology, specifically advanced technology, has aided with the collection and generation of data. The next step requires practices to send in summarization reports of collected metrics to the program, under deadlines. Following this stage, CMS will conduct an analysis of your data, matching your outcomes on specific objectives to nationally recognized benchmarks in the field. CMS will then share these results with you, along with the determination of your projected reimbursement. This number may include any incentives given for above-average delivery of care. In addition, if you participate in one of the other CMS programs, for example an advanced APM, then you may be eligible for further incentives.
This is the theoretical framework of the program. However, in the last two years, how has the program functioned in practice? CMS recently released results that provide an illustration of the QPP in its second participation year[2]. Of note, the number of eligible physicians who are electing to participate in the QPP has increased from its initial year, from 95% to 98%. The proportion of participating physicians who hail from small practices has also increased significantly, currently up to 90% of the total workforce nationwide. In addition, increasing program membership has not been linked to any decrease in reimbursement. Quite the opposite. In this program year, it is reported that 97% of participating physicians will earn a positive payment adjustment, or incentive, in 2020 as a result of meeting metrics in the program year 2018. Such results reflect CMS’ decision to align quality of care with payment and reimbursement, in a thoughtful, engaged manner.
Moving
forward, the QPP continues to be a work-in-progress, shaped by the successes of
years prior with attention to the areas of improvement in the past. Physicians
are encouraged to be involved in the program’s development by dispersing
feedback to CMS and the QPP, thus ensuring that high-quality, compassionate
care is at the center of the U.S. healthcare system.
[1] “Quality Payment Program Overview.” QPP, Centers for Medicare and Medicaid Services, 2017, qpp.cms.gov/about/qpp-overview.
[2] Ellison, Ayla. “CMS Releases Quality Payment Program Results: 5 Takeaways. CMS Released Preliminary Second-Year Participation Data for the Quality Payment Program on July 11.” Becker’s Hospital Review, 15 July 2019, www.beckershospitalreview.com/finance/cms-releases-quality-payment-program-results-5-takeaways.html.
