The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reformed Medicare physician payment to improve physician incentives and provide greater predictability. In a new insight, Director of Health Care Policy Michael Baker explains the legislation’s objectives, and whether it has accomplished those aims.

Key points:

• MACRA had both short- and long-term goals: repeal Medicare’s Sustainable Growth Rate formula and move Medicare fee-for-service physician payment away from volume and toward value.
• The law succeeded in ending a recurring “doc fix” issue that elicited routine congressional attention, but its Quality Payment Program – which created the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (Advanced APMs) – has not demonstrated that it can meaningfully improve value in fee-for-service Medicare.
• MACRA’s record is mixed: MIPS has produced high clinician scores and small payment adjustments, while Advanced APMs have increased participation in accountable payment arrangements but have not clearly generated net Medicare savings once bonuses, shared-savings payments, and other costs are included.

Read the analysis.