The New MACRA Committee

The Commission on Economics goes into operational mode as it approaches new payment models.

Econ chair

The Commission on Economics has known for years that a transition from volume- to value-based payment is inevitable. As early as 2001, “Crossing the Quality Chasm: A New Health System for the 21st Century,” a report published by the Institute of Medicine, called for “aligning payment policies with quality improvement” and “bundled payments for priority conditions.”

 There have been a number of policies moving toward this goal, but changes have been implemented relatively piecemeal. Accordingly, the Commission on Economics has taken action and made recommendations that were largely predictive of what may be required of radiology in the future. Under the visionary leadership of our past chair, Geraldine B. McGinty, MD, MBA, FACR, we created the Value-Based Payments Committee, the ACO Committee, the Radiology Integrated Care Network, and, more recently, the Merit-Based Incentive Payment System (MIPS) Workgroup.

The replacement of the Sustainable Growth Rate by the Medicare Access & CHIP Reauthorization Act (MACR A) has dramatically changed things. MACR A creates a blueprint for future payment models in the form of MIPS and alternative payment models (APMs). However, the rules and regulations under MACR A must still be finalized, and MACR A mandates a remarkably aggressive timeline for this to occur. At the same time, a number of inf luential bodies are informing policymakers on the structure of new payment models under MACR A, including the Centers for Medicare & Medicaid Innovation, the Health Care Learning and Action Network, and the Physician-Focused Payment Model Technical Advisory Committee. This requires action by the ACR on multiple fronts, and the Commission on Economics will be a leader in this effort.

To satisfy this calling, the Commission on Economics has created a new MACR A Committee. The committee consists of experts in the various nuances of MACR A: quality metrics, value-based care, alternative payment models, and our current payment systems. I have appointed Gregory N. Nicola, MD, to chair the committee. Dr. Nicola, a private practice radiologist in New Jersey, has been a thought leader on MACR A since its inception. Before that, he was an early adopter of quality programs (which will translate to the MIPS Performance categories), such as the Physician Quality Reporting System, the ACR Qualified Clinical Data Registry, and meaningful use. Dr. Nicola is also an expert on the Medicare Physician Fee Schedule, actively serving as the American Society of Neuroradiology advisor to the Relative Value Scale Update Committee (RUC).

The MACRA committee will review all rule-making language and help generate ACR’s comments. Likewise, the committee will engage with the influential bodies. I mentioned earlier, reviewing the documents and recommendations and commenting when necessary. While the MACRA Committee will play an important role, we will not do it alone. The committee will collaborate with other ACR commissions, such as Government Relations, Informatics, Patient- and Family-Centered Care, and Quality and Safety. The committee will evolve, as the regulatory climate affecting new payment models changes. This may require specific workgroups or even the spinoff of new more focused committees.

The general blueprint for the future of radiology payment is available through MACRA. The details are yet to be determined. The ACR stands ready to inform discussions around the future of radiology reimbursement and to help ensure radiology’s vital role in the future of health care. The MACRA Committee will be an important contributor in this effort, and I thank the committee’s members for their expertise and service.


SilvaBy Ezequiel “Zeke” Silva III, MD, FACR, Chair

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