News from the AGA

How does the Quality Payment Program affect you?


AGA asks Congress and CMS to continue to implement the Quality Payment Program (QPP) in a way that maximizes flexibility and success for you and your Medicare patients.

Most gastroenterologists participate in the Merit-Based Incentive Payment System (MIPS), which means how the QPP is implemented impacts the entire GI profession. The QPP replaced the sustainable growth rate (SGR) formula in 2015 when the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law. The QPP is comprised of two tracks: MIPS and Advanced Alternative Payment Models (Advanced APMs).

CMS has designated 2017 and 2018 as transition years to allow providers to learn about the QPP and to gradually increase their preparedness for MIPS.

Congress also recently acted to provide CMS additional flexibility with respect to QPP and MIPS implementation, including:

• Excluding Medicare Part B drug costs from MIPS payment adjustments.

• Eliminating improvement scoring for the cost performance category for the second through fifth years of MIPS.

• Allowing CMS to weight the cost performance category at less than 30 percent, but not less than 10 percent for the second through fifth years of MIPS.

• Allowing CMS flexibility in setting the performance threshold for MIPS in years two through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year.

QPP implementation is a top priority for AGA to ensure that the value of specialty care is recognized. Learn more on our website

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