What is MACRA?

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the healthcare financing system in the most significant and far reaching way since the Program's inception in 1965.

MACRA repealed the flawed Sustainable Growth Rate (SGR) payment system which governed how physicians and other clinicians were paid under Part B of the Medicare program. It replaced the SGR, and its fee-for-service (FFS) reimbursement model, with a new two-track system that requires physicians and clinicians to accept downside risk: Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

MACRA History

MACRA replaces the 1997 Balanced Budget Act's SGR that was used to determine annual physician payment updates. After approximately 20 so called "doc fixes," MACRA was passed to replace the SGR in part because the formula neither addressed service frequency and intensity nor quality improvement.

Basic Facts:

  • MACRA Passed with over 90% Congressional support on April 16, 2015

  • MACRA Title I replaces SGR formula annual physician update methodology

  • The new law establishes a 0.5% annual physician fee update from 2015 through 2019

Beginning in 2019 the annual physician fee update will be calculated using one of two payment methods:

  • Merit-based Incentive Payment System (MIPS): +/- Payment Adjustment

  • Alternative Payment Models (APMs): 5% Bonus for qualifying participants in an advanced APM

Important Resources

We have assembled essential background materials to help familiarize you and your organization with key details surrounding MACRA. As you may notice, we often use acronyms in our congressional correspondence, and sometimes they can be tough to decipher. To help translate the material we've developed a glossary of key policy acronyms that you may find useful.

MACRA and Our Summary

Proposed Rule and Our Summary

Issue Briefs on MACRA and Risk

MACRA Implementation Timeline

Our Work

We continue to work with Congress and CMS to make sure you have the tools you need to succeed under MACRA and the time to prepare for taking on risk. You can read our letters to Congress and correspondence related to MACRA and risk below:

Have a specific question on the new physician payment system? We welcome your questions and feedback.