Value-based payment programs tie healthcare reimbursement rates to quality care by offering providers incentive payments to meet specified quality measures during and after healthcare delivery.
As the industry moves away from fee-for-service models and toward value-based care models, CMS has implemented several programs to improve patient care, advance population health, and lower healthcare costs.
These value-based payment programs determine Medicare reimbursement rates for providers, with CMS offering negative, neutral, or positive reductions depending on provider performance and patient outcomes.
QUALITY PAYMENT PROGRAM
In 2015, legislators passed the Medicare Access and CHIP Reauthorization Act (MACRA), ending the Sustainable Growth Rate formula. MACRA requires all clinicians to participate in the Quality Payment Program (QPP) through one of two possible tracks: the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM).