PQRS and the MACRA: Value-Based Payments Have Moved from Concept to Reality

摘要

From its beginnings in 1965, Medicare costs quickly exceeded initial projections, prompting policy makers to enact a number of remedies during the history of the program. The most recent example is the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA).1 Embedded within the MACRA is the concept of quality metrics being used to assess performance. This concept is not new in American health care delivery. This article will explore the evolution of Medicare physician payments and the concurrent development of this quality-reporting element. Table 1 provides a glossary of terms that are commonly used in the discussion of delivery of care quality.