Medicare Payment Quality Measures

Abstract

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the Medicare Sustainable Growth Rate (SGR) formula. SGR was a source of considerable physician anxiety and hand-wringing on an annual basis when dissension in Congress threatened to result in a failure to reauthorize SGR potentially resulting in a 20% reimbursement reduction, a potentially catastrophic blow to physician practices. MACRA initiated a new structure for physician payment based on pay for performance focused on quality outcomes rather than volume-based payments. Reimbursement under MACRA is divided into two groups, merit-based incentive payment systems (MIPS) and advanced alternative payments models (APMs).