QPP Quality Payment
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QPP Quality Payment Program for Health Care Organizations

The health care industry seems to always be the focus of negative publicity on a number of levels.  This is due to some of the ways in which costs are on the rise while care hasn’t improved by nearly as much, or that technological improvements, especially for analysis have been slow in coming.  The Department of Health and Human Services (HHS) has taken notice, and has created a new program to help work through many of these issues.  The Medicare Access and CHIP Reauthorization Act (MACRA) has been implemented to improve how health care is being handled, and the Quality Payment Program (QPP) applied to either incentivize or penalize organization for their work.


One of the largest payers of health care claims is Medicare, which is under the prevue of HHS.  Claims costs have seen a significant increase over time, not just for Medicare, but for other health care insurance companies and individual payers.  Some of the increase is tied to technological advances to health care procedures, new inventive ways of providing care and more personnel needed to cover all the different areas within an organization.  However, this doesn’t fully justify the upsurge. 

Some organizations are willing to be upfront and admit that resources aren’t being watched over as carefully as they should, thus, wasteful spending is happening.  These same organizations have also taken steps to eliminate as much wasteful use of time, people and other resources as possible by utilizing health care specific software and analytics to identify problematic areas, set goals and meet new standards, whether these standards are internal or external. 


The use of software is nothing new to most businesses; the applicability of which results in better services, more efficiency and a lowering of cost associated with internal practices.  Health care is just now coming into its own sets of software that is able to handle the complexities of care data and the rigors of ever-changing regulations.  These evolutions to health systems have opened the door to increasing the level of expectation of care, while trying to control costs, which in turn is why a QPP is apropos right here and right now.

QPP is part of the Medicare Access and CHIP Reauthorization Act, and takes into consideration the following categories when reimbursing hospitals and clinics for care of Medicare patients:

  • Quality of Service reports show an increase in the quality of service provided to patients of a span of time
  • Improvement to Health Care Activitiesreports show enactment of new improvement procedures and attest to the results
  • Advancement to Care Datareports show improvement to data security, patient engagement with patient portals or other interface, increased number of electronic prescription as opposed to written, and more use of data-driven analysis
  • Reduction of Costsreports show the cost associated with claims is more appropriate or is more clearly defined for each process and procedure

Because CMS works by a reimbursement basis, the costs associated with care are fronted by the treating facility.  That facility depends on receiving as much back as possible, but they could be penalized for not bettering their system of care and controlling costs in the form of a lower percentage on reimbursements.  Consequently, any organization that works with Medicare patients is subject to these new standards.  This isn’t a bad thing at all, but get health care organization back to thinking about patient care on a more intimate level, rather than a “how many treatments and procedures can I put this patient through” mentality. 


Without a doubt, there are patients that require a lot of medical attention, especially if that patient has many medical ailments.  However, moving away from a fee-for-service to a quality-for-services changes the way in which a doctor works with and tries to engage the patient in his or her own care.  This fact alone will affect things like more positive outcomes, higher patient satisfaction and the ability for patients to be invested in their own health. 

The QPP should be seen as a tool by which health care organization can measure their performance levels and better their operations.  Sometimes it is necessary to work with negative consequences for non-compliance, but at some point or another, each of us is a patient, and there is a level of expectation we have to receive the best health care possible.  There are also voices for change when it comes to the overwhelming increases to the cost of care.  Progress in the health care industry has been slow to materialize, but it is showing that advances to the industry are possible and are now being expected, both by the government and by each of us as users of health care.