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Physician Payment Reform

The passage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate (SGR) and replaced it with two new payment update tracts, the Merit-based Incentive Payment System (MIPS) and CMS Alternative Payment Models (APMs). The MIPS and APM programs are scheduled to go into effect January 1, 2019.

MACRA created the MIPS to replace
the current CMS Quality Initiative
Programs. MIPS incorporates aspects
of several CMS quality programs into
a component score to determine physician payment.

Learn More about MIPS

APMs are a new approach to paying for medical care
incorporating quality and total cost of care,
instead of a traditional fee-for-service payment structure.

Learn More about APMs

*NEW* Academy Fact Sheet for Year 2 of the Quality Payment Program is Now Available1/11/2018

  • To assist members with participation in Year 2 of the Quality Payment Program (QPP), the Academy developed a fact sheet to highlight the program’s changes, as established in the CY 2018 QPP final rule.
  • The fact sheet highlights changes to MIPS, performance categories, participation requirements, and APMs, among other provisions.

To access the Fact Sheet, click here.

CMS Releases Final Quality Payment Program for CY 2018 - 11/9/2017

• The Centers for Medicare and Medicaid Services (CMS) issued the final rule for Year 2 of the QPP, addressing 2018 requirements and future years under the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model programs. 

• An interim final rule was also released for extreme and uncontrollable circumstances where clinicians can be automatically exempt from these categories without submitting a hardship exception application, if they were affected by extreme weather conditions that occurred during the 2017 MIPS performance period.

  • Access the final rule here
  • Read the CMS Year 2 Fact Sheet here
  • Review the Executive Summary here

• CMS listened and worked to address many of the concerns raised by the AAO-HNS in our comment letter on the proposed rule. However, we emphasized the importance of the need to continue to work together with CMS to address remaining concerns about the program, including continued complexity of the programs and the additional burdens placed on members who must understand and meet many of the shifting requirements. 

  • To read the letter submitted to CMS for the QPP final rule, please click here
  • To read the letter submitted to CMS for the QPP proposed rule, please click here

• For questions regarding 2018 final requirements, contact the Health Policy team at

CMS Releases New Quality Payment Program (QPP) Resources

• CMS has added additional resources to the QPP website to help clinicians participate in the MIPS and APM programs. Resources include a MIPS Quick Start Guide and updated fact sheets. Clinicians can also access a web tool on the QPP webpage to check their MIPS participation status. Clinicians can access these resources on the QPP webpage here

APMs are a new approach to paying for medical care incorporating quality and total cost of care, 
instead of a traditional fee-for-service payment structure.