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December 20, 2018

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Made Simple for Medical and Radiation Oncologists: A Narrative Review

Author Affiliations
  • 1Department of Radiation Oncology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas
  • 2Naveen Jindal School of Management, University of Texas at Dallas
  • 3Economics and Health Policy Department, American College of Radiology, Reston, Virginia
  • 4Clinical Affairs Department, American Society of Clinical Oncology, Alexandria, Virginia
  • 5American Society of Radiation Oncology, Arlington, Virginia
JAMA Oncol. Published online December 20, 2018. doi:10.1001/jamaoncol.2018.5631

Importance  The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA) instituted significant changes in payment methods for many Medicare Part B billing providers (eg, clinicians and health care facilities). Fulfilling its measures satisfactorily and adhering to its reporting requirements will significantly affect reimbursement, yet previous surveys suggest that clinicians’ understanding of MACRA is poor. This review provides fundamental background on MACRA for medical and radiation oncologists.

Observations  The Congress.gov database, PubMed, and the Center for Medicare & Medicaid Services website were searched for legislature and publications relevant to the history, structure, and predicted future for MACRA. MACRA originated from concerns of poor-quality care and from the failure of the traditional fee-for-service model and the Medicare Sustainable Growth Rate method to control rising health care costs. The Quality Payment Program of MACRA started the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) system to move from the traditional fee-for-service model to value-based payment. The most recent legislation extended the transitional period for MIPS and removed drugs and biologics covered by Medicare Part B. Currently, the primary APM for medical oncology is the Oncology Care Model, and an APM for radiation oncology is awaiting approval. Despite recent calls from the Medicare Payment Advisory Commission to end MIPS, there is no indication that either MIPS or APMs will be repealed in the near future.

Conclusions and Relevance  MACRA affects the methods of payment for many Medicare Part B billing providers; the included summary equips medical and radiation oncologists with an understanding of its structure and requirements.