PQRS and the MACRA: Value-based payments have moved from concept to reality

Medicare is in a period of transition. Approximately 10 years ago, the 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System and eligible providers were given an opportunity to earn incentives by successfully reporting quality metrics. The Affordable Care Act brought important refinements to PQRS, including the introduction of negative adjustments for nonparticipation. The MACRA recognized that one of the challenges facing practitioners was the disparate nature of the various CMS programs designed to facilitate quality of care and measure resource use. Going forward, these metrics will be aggregated into a single numeric score, which may be attractive to providers. Understanding this evolution is important for radiologists, given the potential modification of provider payments over a range of 18% ± 9% based on successful participation in these programs.