The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Made Simple for Medical and Radiation Oncologists

Abstract

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...

Charting Trends in Medicare Reimbursement for Lower Extremity Imaging

“… 27 Yet, after years of decreasing compensation and Medicare cuts, the sustainable growth rate was removed with the passage of the Medicare Access and Chip Reauthorization Act (MACRA). 17 A new focus was also created on quality health outcomes with the implementation of merit-based incentive payment systems and the alternative payment model. This system allowed for greater reimbursement for providers based on certain metrics measured in their patients, incentivizing quality of care over quantity of care.…”

Implementation of a stereotactic body radiotherapy program for unresectable pancreatic cancer in an integrated community academic radiation oncology satellite network

“…Establishment of a telemedicine platform for select patients, including QA for SBRT patients, would help to mitigate this risk for immunocompromised patients [27]. Another factor contributing to interest in hypofractionated radiation treatment regimens is the impending imple- mentation of episode-based reimbursement and the radiation oncology alternative payment model (APM) [29,30].While COVID-19 delayed the APM rollout, strategies such as pancreas SBRT that provide efficacy while reducing resource utilization are expected to provide a more favorable cost structure than other more resource intensive strategies such as long course chemoradiation. By implementing this in the community, we have also reduced financial burden for patients unable to travel to a major academic center to receive pancreas SBRT.…”

Oncologist Participation and Performance in the Merit-Based Incentive Payment System

“…This is especially important as oncologists commonly report being unprepared to engage in value-based payment models due to unfamiliarity. 1 , 5 In this analysis, we identified provider- and practice-level factors associated with oncologist participation and performance in MIPS.…”