History of the Medicare Access and CHIP Reauthorization Act (MACRA)

The “Medicare Access and CHIP Reauthorization Act” or “MACRA,” was signed into law on April 16, 2015. This bipartisan legislation permanently repeals the sustainable growth rate (SGR) formula and replaces Medicare’s multiple quality reporting programs with a new program that rewards physicians for providing high-quality, high-value health care.  In particular, physiatrists will need to be able to prove and articulate their value, which will mean identifying and defining optimal pathways or mechanisms for physiatric care, advocating for our patients, and producing data that proves our worth. 

The MACRA makes 3 important changes to how Medicare pays those who give care to Medicare beneficiaries. These changes include:

  1. Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.
  2. Making a new framework for rewarding health care providers for giving better care not just more care.
  3. Combining our existing quality reporting programs into one new system.

View highlights of Medicare Access and CHIP Reauthorization Act of 2015 and learn more about the changes.

AAPM&R Responds 

Your Academy worked diligently to read and synthesize the information to determine how it will impact physiatry. On June 27, 2016, your Academy took a stand for the specialty and submitted comments to CMS on the proposed rule.

In the comment letter, your Academy made numerous recommendations to CMS that are impactful for physiatry, including:

  1. Do not begin the first MACRA performance period until July 1, 2017 and allow for an initial six-month reporting period. 

  2. Explicitly recognize continuing medical education (CME) activities provided by a nationally-recognized accreditor as a clinical practice improvement activity.

  3. Provide as much flexibility as possible for APM participants to meet thresholds so that they may achieve the participation levels.

To make sure the voice of physiatry is heard, your Academy also signed on to 3 other comment letters:

  1. American Medical Association

  2. Group of Pain Specialty Societies (including the American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Society of Anesthesiologists, American Society of Interventional Pain Physicians, American Society of Regional Anesthesia and Pain Medicine, North American Neuromodulation Society, and Spine Intervention Society)

  3. Physician Clinical Registry Coalition

In addition, your Academy also responded to interim requests for information made by CMS concerning specific sections of the rule, including:

  1. AAPM&R Comment Letter on MIPS, APM, RFI

  2. AAPM&R Comment Letter on Proposed PTAC Process