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MACRA 2.5: the legislation moves forward
  1. Lauren Parks Golding1,
  2. Gregory N Nicola2,
  3. Sameer A Ansari3,
  4. Andrew B Rosenkrantz4,
  5. Ezequiel Silva III5,
  6. Laxmaiah Manchikanti6,7,
  7. Joshua A Hirsch8
  1. 1 Triad Radiology Associates PLLC, Winston-Salem, North Carolina, USA
  2. 2 Hackensack University Medical Center, Hackensack, New Jersey, USA
  3. 3 Radiology, Neurology, and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Department of Radiology, New York University Langone Medical Center, New York, New York, USA
  5. 5 South Texas Radiology Group, San Antonio, Texas, USA
  6. 6 Pain Management Center of Paducah, Paducah, Kentucky, USA
  7. 7 Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
  8. 8 NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Joshua A Hirsch, NeuroEndovascular Program, Massachusetts General Hospital, Boston, MA 02114, USA; hirsch{at}


The Medicare and CHIP Reauthorization Act of 2015 remains the payment policy law of the land. 2017 was the first year in which performance reporting will tangibly impact future physician payments. The Centers for Medicare & Medicaid Services (CMS) considers 2017 and 2018 transitional years before full implementation in 2019. As such, 2018 increases the reporting requirements over 2017 in the form of a gradual phase-in while introducing several key changes and new elements. Indeed, it is the nature of the transition itself that led to the somewhat unique title of this manuscript, i.e., MACRA 2.5. Stakeholder feedback to the CMS regarding the program has ranged widely from the elimination of core components to expanding reporting to non-government payers. This article explores the potential impact on neurointerventional physicians.

  • economics
  • political

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  • Contributors LPG and JAH wrote the original draft. All authors were given an opportunity to review and provide meaningful feedback in the creation of the final draft. All authors approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests ABR and JAH are supported by Research Grants from the Harvey L Neiman Health Policy Institute.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.