Which of the following acts created the Quality Payment Program, changing reimbursement to incentivize value over volume?

• A. MACRA
• B. Medicare for All Act
• C. HITECH
• D. ACA

Answer: (A)

The main idea is shifting Medicare payment from paying for every unit of service to rewarding the value and outcomes of care. The act that created the Quality Payment Program did this by establishing a framework that ties clinician reimbursement to performance rather than volume. The Quality Payment Program has two paths: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Under MIPS, clinicians earn a composite score based on four performance domains—quality, cost (resource use), clinical practice improvement activities, and interoperability/public health data exchange. That score determines adjustments to Medicare Part B payments, nudging reimbursement up or down according to value and efficiency. Those participating in Advanced APMs can receive higher incentive payments and may move into a different risk-sharing track if they meet certain criteria. The goal is to encourage better outcomes, more efficient care, and better care coordination rather than simply increasing the number of services provided.

Other common policies did not create this program: the Affordable Care Act expanded coverage and introduced various demonstrations; HITECH funded electronic health record adoption and meaningful use; the Medicare for All Act is a policy proposal not enacted. MACRA is the statute that established the Quality Payment Program and the move toward value-based reimbursement.