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MACRA 2.0: are you ready for MIPS?
  1. Joshua A Hirsch1,
  2. Andrew B Rosenkrantz2,
  3. Sameer A Ansari3,
  4. Laxmaiah Manchikanti4,5,
  5. Gregory N Nicola6,7
  1. 1NeuroEndovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Radiology, New York University Langone Medical Center, New York, New York, USA
  3. 3Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4Pain Management Center of Paducah, Paducah, Kentucky, USA
  5. 5Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
  6. 6Hackensack Radiology Group, Pennsylvania, USA
  7. 7Hackensack, New Jersey, USA
  1. Correspondence to Dr J A Hirsch, NeuroEndovascular Program, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Gray 241B, Boston, MA 02114, USA; Hirsch{at}


The annual cost of healthcare delivery in the USA now exceeds US$3 trillion. Fee for service methodology is often implicated as a cause of this exceedingly high figure. The Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) to pilot test value based alternative payments for reimbursing physician services. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law. MACRA has dramatic implications for all US based healthcare providers. MACRA permanently repealed the Medicare Sustainable Growth Rate so as to stabilize physician part B Medicare payments, consolidated pre-existing federal performance programs into the Merit based Incentive Payments System (MIPS), and legislatively mandated new approaches to paying clinicians. Neurointerventionalists will predominantly participate in MIPS. MIPS unifies, updates, and streamlines previously existing federal performance programs, thereby reducing onerous redundancies and overall administrative burden, while consolidating performance based payment adjustments. While MIPS may be perceived as a straightforward continuation of fee for service methodology with performance modifiers, MIPS is better viewed as a stepping stone toward eventually adopting alternative payment models in later years. In October 2016, the Centers for Medicare and Medicaid Services (CMS) released a final rule for MACRA implementation, providing greater clarity regarding 2017 requirements. The final rule provides a range of options for easing MIPS reporting requirements in the first performance year. Nonetheless, taking the newly offered ‘minimum possible’ approach toward meeting the requirements will still have negative consequences for providers.

  • Economics

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  • Contributors JAH drafted the original manuscript. All authors reviewed the draft, provided meaningful edits, and contributed to the final version.

  • Competing interests JAH consults for Medtronic. ABR is supported by a research grant from the Harvey L Neiman Health Policy Institute.

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