Medicare reform addressed the sustainable growth rate (SGR) formula, which was eliminated with a bipartisan supra-majority of Congress, both House and Senate, in 2015 with the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA created a two-track physician payment incentive program that includes a Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
In January 2015, Secretary of Health and Human Services (HHS) Sylvia Burwell announced a timeline and measurable goals to shift the Medicare program away from traditional fee-for-service payment structure toward a more outcome-based system based on APMs tied to quality.1 Currently, more than 20 percent of Medicare fee-for-service payments flow through APMs, putting the Administration’s goals of 30 percent by the end of 2016 and 50 percent by 2018 within reach.2 This is the first time in the history of the program that explicit goals for alternative payment models and value-based payments have been...