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 through one of two pathways:

MIPS combines and replaces the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM) and Medicare EHR Incentive (Meaningful Use) programs into one comprehensive program. The MIPS program involves four performance categories: Quality, Promoting Interoperability (PI), Improvement Activities (IA) and Cost.

To date there have been two program years with varying requirements. 

  • 2017 – Physicians and practices were allowed flexibility in the first year of the program through the “Pick Your Pace” program. Recognizing the complexity of MIPS, the “Pick Your Pace” program allowed physicians to participate in the program at different levels based on their readiness. In 2017, radiation oncologists could avoid a negative payment adjustment in 2019 by submitting a minimum amount of data for the 2017 reporting period. Two of ASTRO’s programs, RO-ILS and APEx, were available to help radiation oncologists meet the Improvement Activities category. The Quality Oncology Practice Initiative (QOPI®) Reporting Registry brought to you by the American Society for Clinical Oncology (ASCO) and ASTRO, allowed radiation oncologists to report all performance categories. Eligible clinicians who chose not to comply with MIPS during the 2017 performance period are subject to a 4 percent payment reduction in 2019.
  • 2018 – While the majority of the 2017 program basics remain the same for the 2018 performance year—including the use of RO-ILS and APEx to meet the Improvement Activities category and the ability to utilize the QOPI Reporting Registry for data collection and submission—there are a number of significant changes. Review ASTRO’s 2018 Overview to learn more about the differences between the 2017 and 2018 program years. Radiation oncologists will need to do more in 2018 than in 2017 to avoid the negative payment adjustment. Eligible clinicians who choose not to comply with MIPS during the 2018 performance period are subject to a 5 percent payment reduction in 2020.
Performance and Payment Cycle
ASTRO Education
External Resources
QCDR Quality Oncology Practice Initiative (QOPI®) Reporting Registry brought to you by ASCO and ASTRO is now available! This Qualified Clinical Data Registry (QCDR) supports continuous quality improvement that meets federal quality programs.
2018 MIPS Many radiation oncologists will participate in MIPS in 2018. Medicare will adjust payments positively or negatively based on Quality, Promoting Interoperability, Improvement Activities and Cost performance categories.
2017 MIPS A majority of radiation oncologists were expected to participate in MIPS in 2017. Medicare will adjust payments positively or negatively based on Quality, Advancing Care information and Improvement Activities in 2019.
Alternative Payment Models APMs require physicians to take on risk and responsibility for their own cost and quality performance. Participants are eligible for a 5 percent incentive payment for participating in an Advanced APM.
Measures ASTRO is committed to developing quality measures that are meaningful and relevant to radiation oncologists through independent development efforts. ASTRO’s goal is to continue incorporating these measures into the MIPS program.

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