Since 2015, the Quality Payment Program (QPP) has been the framework guiding the shift from volume to value. Created by the Medicare Access and CHIP Reauthorization Act (MACRA), QPP replaced the Sustainable Growth Rate (SGR) formula and consolidated prior reporting programs like PQRS, Meaningful Use, and the Value-Based Payment Modifier into one performance-based system.

At its core, QPP has two aims:

• Reward high-quality, cost-efficient care.
• Improve health outcomes through accountability and continuous improvement.

The QPP Pathways QPP offers two primary participation tracks:

1. Merit-Based Incentive Payment System (MIPS)
2. Advanced Alternative Payment Models (APMs)

1. Merit-Based Incentive Payment System (MIPS) As the default pathway for most clinicians, MIPS scores providers across four performance categories on a scale of 0 to 100:

• Quality (30%) - Requires reporting on at least six measures (including one outcome measure). Assesses the effectiveness, safety, and patient-centeredness of care.
• Cost (30%) - Uses CMS-calculated measures like Total Per Capita Cost and Medicare Spending Per Beneficiary to evaluate efficiency.
• Improvement Activities (15%) - Measures engagement in activities that improve clinical practice, patient engagement, or population health. Providers attest to completing activities worth 40 points during the performance year.
• Promoting Interoperability (25%) - Focuses on the use of CEHRT to improve information exchange and patient engagement. Hospital-based clinicians may be exempt, shifting the weight to Quality.

Each category is weighted (as shown in percentages above) to determine the final score (although typically standardized across the board, weights may vary for hospital-based providers). This final score then impacts whether Medicare Part B payments are adjusted up, down, or held neutral. With that said, the financial impact of the final score is as follows: ±9% payment adjustment applied two years after the performance year (e.g., PY 2024 scores affect 2026 payments).

2. Advanced Alternative Payment Models (Advanced APMs) Next, for providers ready to take on greater risk, Advanced APMs offer an alternative that rewards participation in innovative care models. To qualify, a model must:

• Include both upside and downside financial risk.
• Involve quality measures.
• Require the use of Certified Electronic Health Record Technology (CEHRT).

Additionally, Qualifying Participants (QPs) in Advanced APMs earn a 1.88% incentive payment (in 2026 for PY 2024 performance) and a higher annual Medicare conversion factor update (0.75% vs 0.25%), while being exempt from MIPS reporting.

Which Path Is Right for You? ACOs, large multi-specialty groups, and health systems often pursue the Advanced APM track, especially through programs like the Medicare Shared Savings Program (MSSP), where existing infrastructure supports care coordination, analytics, and governance for risk-bearing arrangements.

Small practices and specialty groups often begin with MIPS, using it as a structured on-ramp to value-based care without immediately taking on downside risk. Choosing the right path depends on organizational size, patient mix, data capabilities, and readiness to manage risk.

Facility-Based Measurement Option For eligible hospital-based clinicians and groups, CMS offers a facility-based scoring option. Quality and Cost scores can be based on the hospital’s performance in the Hospital Value-Based Purchasing (HVBP) Program, removing the need to separately report quality measures unless desired.

Why Reporting Matters Both MIPS and Advanced APM participation link payment directly to performance. Inaccurate or incomplete reporting can mean missed incentives or financial penalties that last for years. Strong reporting:

• Protects revenue by avoiding penalties.
• Enhances credibility with payers and partners.
• Identifies performance gaps early so they can be addressed in real time.

CMS-Qualified Registries Accurately and confidently reporting can be overwhelming – that's why Qualified Registries exist. A CMS-Qualified Registry is an approved third-party entity that collects, validates, and submits quality data to CMS on behalf of clinicians and organizations. By simplifying measure selection, ensuring accurate reporting, and providing timely performance feedback, registries help participants meet QPP requirements and improve their results.

As a CMS-Qualified Registry, Quantician turns QPP’s complexity into a clear, actionable strategy:

• Translating measures into plain language and practical steps.
• Streamlining submissions across MIPS and APM participation.
• Providing ongoing performance feedback to keep scores on track.

Whether you’re an ACO working through Advanced APM requirements or a practice aiming for MIPS success, the right registry partner helps you excel.

The Pathway Forward The Quality Payment Program is here to stay, and so is the expectation that Medicare payments reflect both the quality and efficiency of care delivered. Whether starting in MIPS or preparing for the Advanced APM track, understanding the fundamentals is the first step toward maximizing opportunity. With a strong strategy, sound infrastructure, and the right partner, QPP becomes less of a compliance burden and more of a competitive advantage.