Quality Payment Program

Established through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Quality Payment Program (QPP) is comprised of two tracks: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).


It is important to understand the QPP to ensure you are doing everything required. Ignore QPP requirements and you will face automatic reductions to your Medicare payments.

Have questions? Visit the AGA Community to discuss the QPP, quality reporting and other aspects of the program with your colleagues.


2018 Reporting

The QPP final rule, released in October 2017, provides additional details on year two program requirements.

Read the Rule


2017 Reporting

The QPP final rule, released in October 2016, confirmed that the first performance period begins Jan. 1, 2017, which CMS describes as a “transition year.”

Read the Rule


Which QPP Pathway Will Affect You?

The majority of gastroenterologists are expected to participate in MIPS as few Advanced APMs are avialable for specialty physicians. Plan now to avoid cuts.


Advanced APMS

Advanced Alternative Payment Model (APM)

  • Most appropriate for large systems.
  • Advanced APMs focus on care coordination, share financial risk.
  • Avoids MIPS penalties and qualifies for lump-sum incentive payments by adhering to stringent standards and risk-sharing requirements.
  • There are no GI-specific advanced APMs at this time.


Merit-Based Incentive Payment System (MIPS)

  • Most GIs will participate in MIPS.
  • MIPS replaces current reporting systems.
  • Avoid a 2019 payment penalty by participating in an Improvement Activity through the 2017 pick your pace program, such as:
    • AGA Clinical Guidelines
    • Manage My Surgery
    • SonarMD



What Do You Need To Do?


You need to prepare now for the QPP. Choose the practice model below that best describes your practice to see what you need to be doing right now to avoid future penalties.

GI-Only Practices

The QPP, especially MIPS, will have a profound impact on GI-only practices, from solo practitioners to large groups. AGA has resources for your specific needs to help you prepare.

AMC & Multispecialty Groups

GIs employed by multi-specialty groups and academic medical centers shouldn't assume their institution will take care of their QPP requirements. AGA identifies what you need to do to make sure you’re ready.



The GI’s Guide to MACRA

Walk through the basic information about key programs under MACRA.

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What is MACRA?

MACRA legislation was created to repeal the longstanding sustainable growth rate (SGR) formula, which threatened ongoing untenable cuts to physician payment. As part of the SGR repeal, Congress mandated that CMS undertake a major overhaul of existing payment and quality programs.

There is a five-year transition period to a more quality- and value-based Medicare program during which CMS provides stable payment updates to physicians. Once fully implemented, MACRA will absorb existing programs, such as EHR Incentive Program and meaningful use requirements, the Value-based Payment Modifier, and PQRS. Read More

What is the Quality Payment Program?

CMS recently released proposed rules implementing its new Quality Payment Program (QPP), which was created after Congress passed the MACRA legislation. The QPP provides physicians with the choice to participate in either the new Merit-based Incentive Payment Systems (MIPS) or, as an alternative to MIPS, advanced alternative payment models (APMs). Read More

What is Advancing Care Information?

Advancing Care Information (ACI) is one of four categories on which eligible clinicians will be scored. It was created to provide a measure of partial credit for clinicians who are making progress in implementing new technology. Read More

What are Improvement Activities?

Improvement Activities is one of four categories on which eligible clinicians will be scored. It  was created to lead to improvements in the patient care experience. Read More

Downloadable Guides to MACRA

MIPS At-a-Glance

Proposed Medicare and Quality reorms Report

The AGA Report on the Merit-based Incentive Payment System (MIPS) provides a comprehensive, but plain-language, analysis of the program, including specific requirements and how GI's can participate.

QPP at-a-Glance

MACRA Infographic

Download a printable infographic with all the basics at-a-glance.


Additional MACRA Resources


Performance Measures

AGA is a leader in performance measurement and has developed measures for several digestive health conditions and clinical topics including: colorectal cancer screening and surveillance, HCV and IBD.

Performance Measures

Regulatory Comments

AGA reviews proposed and final federal regulations to provide expertise and guidance on rules that will impact the field of gastroenterology, AGA members and their patient care We provide substantive policy support and expertise to  CMS and other regulatory departments since physicians are best suited to provide guidance to rules that will affect their patient care.

Regulatory Comments