Medicare Access and CHIP Reauthorization Act (MACRA)

Learn about MACRA. Visit our MACRA FAQs, glossary page and this section to find the most up-to-date information on this important and developing topic. And watch your inbox for MACRAlerts.  Each MACRAlert will provide vital MACRA news.


What is MACRA?

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As the policies passed in this new legislation are rolled out over the coming years, comprehensive changes in how Medicare pays physicians for services will be introduced. Reimbursement for rheumatologists and their practices will change significantly. The law:

  • Repeals the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care services
  • Changes the way that Medicare rewards clinicians moving away from fee-for-service and toward payment based on value

Under MACRA, nearly all physicians will have to choose between one of two paths: Merit-Based Incentive Payment System (MIPS), which consolidates existing Medicare fee-for-service physician incentive programs such as PQRS and meaningful use or participation in an Alternate Payment Model (APM)

“It is imperative that the rheumatology community understands the impending long-term effects of MACRA and engages in strategic thought about the best option for their practice. The ACR will be there, providing up-to-date information and support for its members. Information will be our most important tool in getting ahead of the curve and succeeding in this rapidly changing environment.” More >

- Joan M. Von Feldt, MD, MSEd, ACR Past President

Two Payment Tracks

The Quality Payment Program (QPP) has two tracks to choose from which allow you to participate based on your practice size, specialty, location, or patient population: MIPS and APMs.

Merit-Based Incentive Payment System (MIPS)

  • MIPS changes how Medicare links performance to payment.
  • MIPS consolidates three current programs: the EHR Incentive Programs/Meaningful Use (MU), Physician Quality Reporting System (PQRS) and Value Based Modifier (VBM) into one quality program.
  • MIPS will evaluate four performance categories: Quality, Resource Use, Clinical Practice-Improvement Categories and Advancing Care Information (MU) . An eligible professional’s (EP) performance score will be used to determine if an EP receives a positive, negative or zero payment adjustment.
  • For physicians who select the MIPS track, a methodology will be used to assess their total performance for Medicare beneficiaries and each MIPS eligible physician will receive a composite quality score for each performance period.

Note: Details on MIPS will be the subject of policymaking for several years, but it is important to understand that some of the assessments made at the effective date of 2019 will be based upon 2017 data.

MIPS composite score

MIPS adjustment to provider base rate

Alternate Payment Models (APMs)

  • MACRA promotes the development of an eligible professional’s participation in Alternate Payment Models (APMs), which create a payment incentive program for qualifying participants.
  • From 2019 through 2024, qualifying APM participants will receive a lump sum incentive payment equal to five percent of the prior year’s estimated aggregate expenditures under the fee schedule. Qualifying APM participants will not be subject to MIPS adjustments
  • Eligible APMs are the most advanced APMs that meet the following criteria according to the MACRA law: Accountable Care Organizations, Patient Centered Medical Homes and bundled payment models.
  • Base payment on quality measures will be comparable to those in MIPS.

January 1, 2017: On this date the data from your practice began counting for Medicare reimbursement in 2019.

ACR Support and Involvement

MACRA will transform how rheumatology practices/clinicians (1) conduct Medicare reporting requirements, and (2) are paid for the services provided to Medicare beneficiaries. The ultimate goal of these changes is to move toward a value-based healthcare system that ensures high-quality, affordable health care- quality over quantity.

To begin preparing its members for MACRA, ACR leadership from a number of highly engaged committees have joined forces to develop an action plan for the organization’s involvement in the implementation of the new law. This new ACR MACRA Working Group is developing an education, communication and advocacy strategy and is committed to helping our members navigate through the complexity of MACRA as it rolls out.

What You can do Now to Prepare

The ACR is committed to providing its members with resources and support to steer through the complication of MACRA.

  • There is a great deal to learn. Become informed starting now. January 1, 2017 was a significant date. That’s the day data about your practice started counting for reimbursement in 2019. If you haven't done anything before January 1, 2017, you’ll have missed an opportunity to get your practice ready for changes coming in the near future.
  • Choose a payment pathway. Almost without exception, everyone in the United States will be forced into one of two tracks: MIPS or APM. The ACR is highly engaged in working to influence the rules that define APMs and MIPS so that they make the most sense for rheumatologists and the medicine you practice and we will keep you informed as the details unfold.
  • Join RISE. Rheumatology Informatics System for Effectiveness (RISE) is a Qualified Clinical Data Registry (QCDR), created and administered by the ACR. RISE represents a vital tool for survival in the pathway called MIPS.

Updated March 6, 2017