Background
On Oct. 14, 2016, the Centers for Medicare & Medicaid Services (CMS) released the final rule
implementing the new Medicare Quality Payment Program (QPP). Mandated by the Medicare Access
and CHIP Reauthorization Act (MACRA), the QPP replaces the former sustainable growth rate (SGR)
payment system, under which physicians had faced nearly 14 years of significant Medicare pay cuts —
passage of MACRA prevented Medicare cuts of nearly $100,000 for many neurosurgeons: $42,000
related to the SGR; $22,000 for quality programs; and $30,000 preventing the elimination of 10- and 90-
day global surgery codes. The new payment system also consolidates Medicare’s separate quality related programs — the Physician Quality Reporting System (PQRS), Electronic Health Records (EHR)
Incentive Program and Value-Based Payment Modifier (VM) — and provides a new framework for
rewarding the delivery of quality patient care through two pathways: the Merit-based Incentive Payment
System (MIPS) or through Advanced Alternative Payment Models (Advanced APMs).
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