Healthcare Data GlossaryRegulatory
QPP: Definition and Healthcare Context
Full name: Quality Payment Program
The Quality Payment Program (QPP) is a CMS framework established by MACRA that replaced the Sustainable Growth Rate (SGR) formula for Medicare clinician reimbursement. QPP offers two participation pathways: MIPS (Merit-Based Incentive Payment System) and Advanced Alternative Payment Models (APMs). Eligible clinicians choose a pathway based on practice size, specialty, and patient volume. QPP ties Medicare payment rates to quality and value metrics. CMS publishes individual and group QPP performance scores as public data accessible through qpp.cms.gov.
Last updated: 2026-06-17Reviewed by: Dr. Jennifer Montecillo, MD — Gullas College of Medicine, 2019. Non-practicing medical reviewer.
How it’s used
- CMS QPP MIPS: QPP individual performance data is ingested by Fonteum to surface MIPS scores on provider profiles, keyed by NPI.
Frequently asked questions
- What is the QPP?
- The Quality Payment Program (QPP) is CMS's framework for tying Medicare clinician payment to quality and value metrics, established by MACRA. It offers MIPS and Advanced APM pathways.
- What are the two QPP pathways?
- MIPS (Merit-Based Incentive Payment System) for most eligible clinicians, and Advanced APMs for providers in qualifying alternative payment arrangements.
- Is QPP participation required?
- Eligible clinicians above QPP volume thresholds are automatically subject to MIPS payment adjustments. Participation in data reporting is technically optional, but non-reporters receive the maximum negative payment adjustment.