he Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015 (MA-CRA) was a monumental shift for the health care industry, as the Centers for Medicare & Medicaid Services (CMS) moved from a traditional fee-for-service (FFS) model toward value-based payment models. With the overarching goals of decreasing health care costs, rewarding high-value providers (hospitals, physician groups, and clinics), and penalizing lowvalue providers, MACRA targeted all Medicare Part B billing providers and established a Quality Payment Program with 2 components: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). 1 Combined, MIPS and APMs provide reasonable flexibility for health care providers, albeit with greater financial risk than that experienced with the traditional FFS model. Despite significant media attention, health care providers' understanding of MACRA remains poor. [2][3][4] As the Quality Pay-ment Program continues to evolve, many specialty-specific considerations have arisen, further complicating education on MACRA at the individual clinician level. To improve medical and radiation oncologists' understanding of MACRA's performance requirements and timeline, this review summarizes the history, structure, and predicted future for MACRA, with special attention to relevant details for medical and radiation oncologists. History of MACRAThe historical timeline of the dominant health care provider payment systems during the last 50 years can be divided into 4 eras: usual, customary, and reasonable cost; the traditional FFS model under the Medicare Volume Performance Standards; the traditional FFS model under the Medicare Sustainable Growth Rate (SGR) method; and, most recently, MACRA. The Social Security IMPORTANCE The Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015 (MACRA) instituted significant changes in payment methods for many Medicare Part B billing providers (eg, clinicians and health care facilities). Fulfilling its measures satisfactorily and adhering to its reporting requirements will significantly affect reimbursement, yet previous surveys suggest that clinicians' understanding of MACRA is poor. This review provides fundamental background on MACRA for medical and radiation oncologists.OBSERVATIONS The Congress.gov database, PubMed, and the Center for Medicare & Medicaid Services website were searched for legislature and publications relevant to the history, structure, and predicted future for MACRA. MACRA originated from concerns of poor-quality care and from the failure of the traditional fee-for-service model and the Medicare Sustainable Growth Rate method to control rising health care costs. The Quality Payment Program of MACRA started the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) system to move from the traditional fee-for-service model to value-based payment. The most recent legislation extended the transitional period for MIPS and removed drugs and biologics...

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My purpose was to compare how radiology is practiced in the United States with how it is practiced in England. Perhaps, I thought, in doing so I could identify lessons American radiologists could learn and then import into their own practices and departments. After all, the American health care system is experiencing fundamental changes at the moment with respect to payment reform. So I wanted to learn all I could about the system in England and share my findings with ACR members.Because my experience consisted entirely of interviewing hospitalbased diagnostic radiologists, I will confine most of this article to dealing with that group and their position vis-à-vis American hospital-based diagnostic radiologists. As my interviews ran their course, one aspect of UK diagnostic imaging seemed appropriate to compare with American radiology at the Imaging 3.0 Ò crossroads: the high level of value referring clinicians place on the diagnostic radiologist's diagnosis.There are as many similarities as there are differences between the two countries when it comes to health care coordination. But one trait of diagnostic radiology as it is practiced in England stands out: radiologists in

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possibly due to being better staffed and working somewhat differently. To improve working conditions in RT, our data suggest that activities focusing on organizational issues and cooperation both within each profession as well as between professions are important. With respect to identified bottlenecks, improved routines at target definition are warranted by all involved professions to increase work effectivity and reduce frustration among RT staff.