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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.
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from the Medicare Payment Advisory Commission to end MIPS, there is no indication that either MIPS or APMs will be repealed in the near future.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.
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Accepted for Publication: September 7, 2018.
Corresponding Author: Ryan T. Jones, MD, MBA, Department of Radiation Oncology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas, TX 75390 (email@example.com).
Published Online: December 20, 2018. doi:10.1001/jamaoncol.2018.5631
Author Contributions: Dr Jones had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Jones, Helm, Grubbs.
Acquisition, analysis, or interpretation of data: Jones, Helm, Parris, Choy, Kapetanovic.
Drafting of the manuscript: Jones, Helm.
Critical revision of the manuscript for important intellectual content: All authors.
Administrative, technical, or material support: Jones, Parris, Grubbs, Choy.
Conflict of Interest Disclosures: Dr Jones reported being a Moorefield Fellow in Economics and Health Policy with the American College of Radiology. Mr Parris reported being an Economic Policy Analyst with the American College of Radiology. Dr Grubbs reported serving as the Vice President of Clinical Affairs with the American Society of Clinical Oncology. Ms Kapetanovic reported being a Quality Improvement Manager with the American Society of Radiation Oncology. No other disclosures were reported.
Disclaimer: The information included herein represents the opinions of the authors alone.
Additional Contributions: Pamela Kassing, MPA, American College of Radiology, and Anne Hubbard, BA, MBA, American Society of Radiation Oncology, provided editorial assistance. They were not compensated for their contributions.
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