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Former Federal Quality Reporting Programs

2016 is a critical year for practices to avoid penalties under Medicare's quality reporting programs.

2016 Program Participation

2018 Payment Adjustment

PQRS -2%
EHR Meaningful Use -3% or -4% depending on the number of successful meaningful users
Value-Based Payment Modifier Between -4% and +4x
* x equals the "upward payment adjustment factor" yet to be determined by CMS

For more information about the quality reporting programs and to access MGMA's PQRS, Value-Based Payment Modifier, and Meaningful Use resource centers, click on one of the below buttons:

MGMA is here to support your efforts in participating in these programs. We have helpful resources and tools to help you and your medical group practice understand participation requirements and avoid payment penalties. For more information about the quality reporting programs and to access MGMA’s PQRS, Meaningful Use, and Value-Based Payment Modifier resource centers, click on one of the below buttons.

What’s Next? New Merit-Based Incentive Payment System (MIPS) takes effect in 2017

Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which repealed the failed sustainable growth rate formula, separate penalties applied under the federal PQRS, Value-Based Payment Modifier, and EHR Meaningful Use programs will sunset on Dec. 31, 2018. Beginning in 2019, Medicare will consolidate these three separate programs into a single program known as the Merit-Based Incentive Payment System (MIPS). MIPS will evaluate physician and certain non-physician practitioner performance in four categories:

  1. Quality
  2. Resource use
  3. Meaningful use of EHR technology, and
  4. Clinical practice improvement activities.

Based on performance in these categories, MIPS will assign a composite score of 0 to 100 and compare this score to a pre-determined benchmark. Depending on how their MIPS score compares to the benchmark, providers may earn bonuses or face penalties of up to 4% in 2019. The maximum MIPS bonuses and penalties will gradually increase to 9% in 2022. However, unlike the current programs that use an “all-or-nothing” approach to assigning penalties to eligible professionals who do not satisfy all program criteria, MIPS will use a “sliding scale” to award partial credit for performance.

For more information about MIPS, visit this Centers for Medicare and Medicaid Services (CMS) webpage.

MGMA's position

MGMA strongly supports the harmonization and consolidation of PQRS, VBPM, and meaningful use into a single quality reporting program. As Medicare developed the new framework for MIPS, MGMA aggressively advocated that CMS hit the reset button and develop a program that supports and encourages the group practice model in which providers are measured on costs and clinically-relevant outcomes that are within their control. To help physician practice leaders understand the new program and successfully prepare for its implementation in 2017, MGMA has created new tools and resources available at the MACRA/QPP Resource Center