Discover how the Medicare Access and CHIP Reauthorization Act of 2015 ("MACRA") led the Centers for Medicare and Medicaid Services (CMS) to create a new quality payment program that is transforming how providers are paid.


MACRA is a separate piece of legislation from the Affordable Care Act (ACA), also known as Obamacare. Unlike the ACA, MACRA passed with wide bipartisan support. Although some components of these laws are intertwined, major changes to the ACA under the new administration will not eliminate MACRA.

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What did MACRA do?

  • Permanently repealed the sustainable growth rate (SGR) methodology for determining payment updates to the Medicare physician fee schedule
  • Stabilized physician payments with 0.5% positive updates annually from 2015 through 2019
  • Created a new quality payment program under which physician payments will be based on participation in one of two pathways: Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs)

Access recording and read Q&A for AAN's Practice Management Webinar, "Decoding the 2017 Medicare Physician Fee Schedule and MACRA Rule." 

Latest Updates
  • CMS announces final rule implementing MACRA. Read the AAN's summary of the final rule. (October 14, 2016)
  • CMS has acknowledged the many challenges facing physician practices to implement MACRA and released a plan to allow physicians to pick their pace of participation in the first performance period that began on January 1, 2017.
  • CMS announces its proposal to implement the MACRA law. Learn more about the proposal. Read the AAN's comments to CMS in response to their proposal. (April 27, 2016)
Merit-based Incentive Payment System (MIPS)

MIPS ties Medicare payments to performance by consolidating three existing Medicare incentive programs and adding one new component. MIPS will provide physician payment penalties or bonuses beginning in 2019 based on 2017 performance data.

Under MIPS, neurologists must be prepared to be measured on performance in:

Alternative Payment Models (APM)

Alternative Payment Models (APMs) move providers even further from existing fee-for-service (FFS) payments towards true value-based payments (e.g., bundled payments, global payments). Several broad requirements exist for successful provider participation in APMs, with these requirements to be further clarified during future regulatory rule-making:

  • Takes on "more than nominal" financial risk for attributed patients
  • Reports on quality measures comparable to those under the MIPS program
  • Uses a certified Electronic Health Record (EHR)
  • Meets a threshold percentage, that increases over time, of payments that are linked to value through Medicare or all-payer APMs

Providers who successfully meet the APM criteria will receive a 5-percent annual lump sum bonus every year from 2019 to 2024 and are exempt from the MIPS program.

Access the AAN's APM-specific information.

AAN Tools & Resources
Read Articles About MACRA
Advocating for Neurology
Non-AAN MACRA Resources

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