MACRA: Medicare Access and CHIP Reauthorization Act
MACRA is the 2015 federal law that permanently replaced the Sustainable Growth Rate formula and created the Quality Payment Program, the framework governing how Medicare pays physicians for value rather than volume.
What is MACRA?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is landmark bipartisan legislation that fundamentally restructured how Medicare pays clinicians. Passed with near-unanimous Congressional support, MACRA permanently repealed the Sustainable Growth Rate (SGR) formula — a flawed mechanism that repeatedly threatened double-digit physician payment cuts, requiring Congress to pass "doc fix" patches nearly every year for over a decade.
The Quality Payment Program (QPP)
In place of SGR, MACRA established the Quality Payment Program with two distinct participation tracks:
- MIPS (Merit-based Incentive Payment System): The default track for most eligible clinicians. Performance in four categories — Quality, Cost, Promoting Interoperability, and Improvement Activities — determines Medicare payment adjustments of up to ±9%.
- Advanced APM (Alternative Payment Model) Track: Clinicians who participate sufficiently in CMS-approved models (such as MSSP ACOs, BPCI Advanced, and Primary Care First) can qualify as Qualifying APM Participants (QPs), receiving a 5% incentive bonus and exemption from MIPS reporting through 2024.
Who Must Participate?
Eligible Clinicians (ECs) under MACRA include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who bill more than $90,000 in Medicare Part B charges and provide care for more than 200 Medicare patients annually. Below these low-volume thresholds, clinicians are exempt from MIPS but may voluntarily participate.
Why MACRA Changed Healthcare Analytics
Before MACRA, physician payment was largely transactional. MACRA created a direct financial link between measurable quality performance and Medicare reimbursement, making clinical analytics a revenue function, not merely a compliance exercise. Understanding your MIPS composite score, care gap closure rate, and patient attribution accuracy became directly tied to the bottom line of every eligible practice.