Table 2:

Quality Payment Program—basic breakdown of MACRA

	MIPS	AAPM
Definition	Merit-Based Incentive Payment System	Advanced Alternative Payment Model
Payment adjustment components	Quality (replaces PQRS)	Quality measures like MIPS
	Advancing care information required (eg, use of EMR)	Quality measures like MIPS
	Implementing CPIAs is required	Otherwise, varies on the basis of APM model (eg, BPCI, Next Generation Accountable Care Organization Model, and so forth)
	Measures of cost
Basic inclusion requirements	Fail to meet the 3 requirements to be in an AAPM (see cell to the right)	Use of approved EMR
		Base reimbursement on quality measures like MIPS
		Required to bear “more than nominal” financial risk
Benefits/penalties	Upward or downward adjustment of 4%, based on performance measured in 2017	QPs not subject to budget-neutral payment/adjustment
	Percentage adjustment increases each year, reaching a maximum of ±9% in 2022	Automatic 5% bonus payment based on aggregate Medicare Part B payments during the first 6 years
	Increase in fee schedule conversion factor used to calculate Medicare Part B payments of 0.25% per year	Beginning in 2026, 3-fold increase for QPs in their fee schedule conversion factor used to calculate Medicare Part B payment of 0.75% per year for QPs
Effective date (begins impacting physicians' Medicare Part B reimbursements)	2019	2019

Note:—AAPM indicates Advanced Alternate Payment Model; BPCI, Bundled Payments for Care Improvement Initiative; EMR, electronic medical record; CPIA, Clinical Practice Improvement Activities; QP, Qualifying Participant.