Medicare Access and CHIP Reauthorization Act (MACRA)
The Medicare Access and CHIP Reauthorization Act of 2015 is a federal law that changed how doctors who treat Medicare patients are paid by Medicare. It’s sometimes called the “Permanent Doc Fix” as a result. It also removed Social Security numbers from Medicare cards to prevent identity theft.
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Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
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Brian Hickey, CLU®, CLTC®, FLMI
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- Published: February 22, 2021
- Updated: December 14, 2022
- 3 min read time
- This page features 9 Cited Research Articles
- Edited By
What Is MACRA?
The main goal of the Medicare Access and CHIP Reauthorization Act (MACRA) has been to improve care for Medicare beneficiaries by rewarding health care practices that improve care while reducing costs.
It attempts to achieve these goals through several actions.
- Repealed the Sustainable Growth Rate formula — which had determined payments to doctors prior to MACRA.
- Created the Quality Payment Program (QPP) at the heart of rewarding health care providers for quality of care instead of volume of treatments.
- Streamlined multiple programs under the Merit Based Incentive Payments System (MIPS) to reform payments to clinicians.
- Gave bonus payments for participating in eligible Advanced Alternative Payment Models (APMs) to incentivize efforts to achieve MACRA goals.
MACRA and the Sustainable Growth Rate Repeal
By repealing the Sustainable Growth Rate formula and replacing it with the Quality Payment Program, MACRA is credited with stopping a potential exodus of health care providers from Medicare.
Prior to MACRA, Medicare relied on the Sustainable Growth Rate formula to determine how much to pay health care providers. The formula was supposed to control rising health care costs to Medicare.
The formula had to be adjusted each year and was becoming increasingly unpopular with doctors. It limited payments to doctors without considering the type, complexity and amount of health care provided.
The formula called for a more than 29% cut in payments to doctors in 2012. This led to an increasing number of doctors simply refusing to accept Medicare.
A Texas Medical Association survey in 2011 found that 8% of doctors in that state had already stopped taking new Medicare patients. Another 22% planned to stop and 415 were considering whether or not to stop accepting new Medicare patients.
The Sustainable Growth Rate formula gave doctors incentives to schedule more visits, order more tests and perform more procedures for Medicare patients. MACRA shifted that incentive toward improving the quality of care and cutting overall costs by offering bonuses to health care providers that met that balance.
How Does the Quality Payment Program Work?
The Quality Payment Program is an incentive program at the core of the Medicare Access and CHIP Reauthorization Act. This is the mechanism that changed and simplified how Medicare pays health care providers for the care they provide.
Health care providers have two options for taking part in the Quality Payment Program: The Merit Based Incentive Payments System (MIPS) and Advanced Alternative Payment Models (APMs).
- Merit Based Incentive Payments System
- MIPS is a system that determines a health care provider's Medicare payment adjustment. The system uses a composite score based on the clinician’s performance to determine whether the provider receives a payment bonus, a penalty or no payment adjustment aside from what Medicare has already paid.
- Advanced Alternative Payment Models
- APMs provide added incentive payments for providing quality and cost-efficient care. Health care providers who take part in advanced APMs can earn Medicare incentive payments of 5% for taking part in a participating innovative payment model. An Accountable Care Organization is an example of an APM.
MACRA, Your Medicare Card and Identity Theft Protection
MACRA mainly affected the payment relationship between Medicare and health care providers. People on Medicare should have noticed few if any changes aside from one: MACRA also required Medicare to remove Social Security numbers from all Medicare cards.
This move was intended to improve security for Medicare beneficiaries.
Medicare replaced all affected cards by mid-January 2019. The new cards, and every card issued since the change took effect, now use randomly generated letter and number combinations called Medicare Beneficiary Identifiers, or just Medicare numbers.
The intent of the law was to keep beneficiaries’ private health care and information along with their federal benefit and service payment information safe from identity theft.
9 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, March 23). What’s the Quality Payment Program? Retrieved from https://www.cms.gov/Medicare/Quality-Payment-Program/Quality-Payment-Program
- U.S. Centers for Medicare & Medicaid Services. (2019, November 18). MACRA. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs
- Gruessner, V. (2016, September 23). How MACRA Resolves Sustainable Growth Rate Formula Challenges. Retrieved from https://healthpayerintelligence.com/news/how-macra-solves-challenges-of-sustainable-growth-rate-formula
- Parks, T. (2016, March 6). Why MACRA Matters for Your Practice. Retrieved from https://www.ama-assn.org/practice-management/medicare-medicaid/why-macra-matters-your-practice
- Network for Regional Healthcare Improvement. (n.d.). Medicare Access and CHIP Reauthorization Act (MACRA). Retrieved from https://web.archive.org/web/20220518231949/https://www.nrhi.org/macra/
- American Academy of Family Physicians. (n.d.). The Medicare Access and CHIP Reauthorization Act (MACRA). Retrieved from https://www.aafp.org/family-physician/practice-and-career/getting-paid/macra.html?cmpid=Macra_pe_pa_na_qr_fmx
- HealthIT.gov. (n.d.). MACRA. Retrieved from https://www.healthit.gov/topic/meaningful-use-and-macra/macra
- EHR Intelligence. (n.d.). What Is MACRA and What It Means to Providers, EHR Technology. Retrieved from https://ehrintelligence.com/features/what-is-macra-and-what-it-means-to-providers-ehr-technology
- Primary Care Collaborative. (n.d.). The Medicare Access and CHIP Reauthorization Act (MACRA) – the Proposed Quality Payment Program. Retrieved from https://www.pcpcc.org/topic/medicare-access-and-chip-reauthorization-act-macra
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