The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)


The Centers for Medicare & Medicaid Services' (CMS) Quality Payment Program (QPP) ended the Sustainable Growth Rate formula with the creation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA has two tracks that clinicians can choose from: the Advanced Alternative Payment Models (APMs), or the Merit-based Incentive Payment System (MIPS). If you provide care for more than 200 Medicare patients a year and bill more than $90,000 in Medicare Part B allowed charges a year or submit data for an APM, then you are in the MACRA program. The AJRR can help its participants meet the requirements for the MIPS track. 

The Merit-based Incentive Payment System (MIPS)

The MIPS track can be very helpful to clinicians, as it will adjust Medicare payments based on the quality and completeness of data submitted to CMS.

Occupations eligible for MIPS include:

  • clinical nurse specialists
  • nurse practitioners
  • certified registered nurse anesthetists
  • physician assistants
  • physicians
For those who participated in MIPS in 2018, quality data needs to be submitted to CMS by April 2, 2019 at 8 p.m. EDT. Medicare will then provide feedback on your performance, and will give you either a negative, neutral, or positive payment adjustment in 2020.

When participants choose not to submit any data, they will receive a negative 5% payment adjustment. They can also choose to submit a mix of measures and categories to earn 15 points, which will give them a neutral payment adjustment. The third option is for participants to submit all four categories of data and earn 16-69 performance points. These participants will recieve a small positive payment adjustment in 2020. The final option is to submit all categories and recieve 70+ performance points. This will earn your practice a moderate positive payment adjustment. The positive and negative adjustments increase each year of the program, as you can see in the diagram below.

MIPS Payment Adjustment Timeline








Now we’ll quickly go over the quality data and technology information categories that are required for MIPS. They are:

  • Quality
  • Advancing Care Information
  • Improvement Activities
  • Cost

You may recognize aspects of these MIPS categories, as most of them replace previous CMS initiatives. The Quality category replaces the Physician Quality Reporting System (PQRS). The Advancing Care Information category replaces the Medicare Electronic Health Record (EHR) Incentive Program, also known as Meaningful Use (MU). The Cost category replaces the Value-Based Modifier (VBM). The Improvement Activities category is new.

How Can AJRR Help?

The American Academy of Orthopaedic Surgeons (AAOS) Orthopaedic Quality Resource Center is a collaboration between AJRR, the American Orthopaedic Association's (AOA) Own the Bone program, the American Association of Hip and Knee Surgeons (AAHKS), and the Orthopaedic Trauma Association (OTA). It's approved by CMS as a Qualified Clinical Data Registry (QCDR). The QCDR provides a standard to complete Merit-based Incentive Payment System (MIPS) requirements based on satisfactory participation. A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. 

The AAOS Orthopaedic Quality Resource Center is comprised of 38 measures, including three AAHKS-sponsored hip and knee measures and the Academy's own 2017 Orthopaedic Preferred Speciality (OPS) List. The AOA’s Own the Bone program has also provided measures that will remain as part of the platform. The AAOS Orthopaedic Quality Resource Center has been a QCDR since 2014.

The AAOS QCDR can assist Eligible Professionals (EPs) and organizations participating in the Group Practice Reporting Option (GPRO) across all orthopaedic specialties. The Resource Center’s MIPS reporting can satisfy the full MIPS program and prevent institutions from receiving up to a 5% negative payment adjustment. Besides for MIPS reporting, AAOS' QCDR can also automate EHR data, track performance against benchmarks, and help manage your patient population.

Contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. to learn more about the AAOS Orthopaedic Quality Resource Center.

Additional Resources

Below are a few additional resources that you can use to become more familiar with MACRA:

The Register

Sign Up for AJRR's Particpant E-newsletter Registry Insider


AAOS AJRR Sept2018 yellow background

The Register

Sign Up for AJRR's Particpant E-newsletter Registry Insider