The Medicare Accessibility and CHIP Reauthorization Act (MACRA), signed into law in April 2015, introduced several changes to the physician reimbursement framework. MACRA replaced the Workable Growth Rate formula with the Quality Payment Program (QPP) to provide incentives payments that emphasize the value and quality of care over the volume. The QPP includes three existing quality reporting programs (PQRS, Value-Based Payment Modifier and Medicare EHR Incentive Program/Meaningful Use) and adds a fourth category, Improvement Activities, into one program.

Under the QPP physicians can participate in either the Merit-based Incentive Payment System (MIPS) or in Advanced Alternative Payment Models (APMs) to avoid descending payment adjustments and potentially receive upward adjustments.

MIPS is designed to be budget neutral, with upward and downward adjustments balanced so that the average change is 0% across reimbursement.

Performance is measured on a calendar year basis, with payment adjustments made one year after the performance measurement period. For 2018, the payment adjustment will be -5% to +5%, paid out in 2020. The range of payments will increase annually to +/- 9% for the 2020 measurement year, paid out in 2022.