With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS did away with the Sustainable Growth Rate model. Now, they are able to reward high-value, high-quality Medicare clinicians with payment increases, while at the same time reducing payments to those clinicians who aren’t meeting performance standards.
CMS intentionally wanted to make sure that the MACRA program was going to get full participation by all or almost all physicians in the country. They wanted to have not only robust participation, but also good performance across the program. So, they created a ramp-up period between 2017 and 2022, with lower performance thresholds that would make it easier for hospital-based providers to achieve higher scores.