Daily Practice

Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP). QPP transitions Medicare payment away from fee-for-service to pay-for-performance, emphasizing quality care. The program represents a significant change in the way all physicians, including radiation oncologists, are paid by Medicare.

Participation in the QPP is split between the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM); however, within those two branches is a lot of variation. The following pages provide a deeper dive into the details of each model:

Physicians can look up eligibility and reporting requirements on the QPP website using their National Provider Identification (NPI) number. Information will include CMS’ analysis of the number of Tax Identification Numbers (TINs) associated with your NPI including MIPS eligibility, APM enrollment, hospital-based designation (more than 75% of services are billed at the hospital), and small practice designation (15 or fewer eligible clinicians) and facility-based scoring. This information will be provided for both the individual (NPI) and group level (TIN). This is a valuable resource to determine clinician specific program requirements, as well as ensure that CMS has the correct information regarding your practice.

To date there have been six program years with varying requirements. Eligible clinicians started with a 4% payment reduction based on the 2017 MIPS performance if they did not participate successfully. This potential penalty has increased over the years and is now a possible 9% reduction on 2025 Medicare payments if they do not participate.

Score and Payment Attribution

ASTRO and CMS have many resources to help you determine the best path for your practice. Contact ASTRO for more information.

Measures Measures are a mechanism to assess quality indicators in various aspects of the delivery of health care and may be used internally or externally with a direct link to physician reimbursement.
Alternative Payment for Radiation Oncology ASTRO continues to work toward a Radiation Oncology Alternative Payment Model that functions as a viable and meaningful values-based payment opportunity for radiation oncology.