By Eric Andrew Kristof, RN, CAHIMS | Healthcare IT Professional | HIMSS Arkansas Chapter Member
About This Series: The HIMSS Word of the Day is a running blog series drawing from the HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025) — the authoritative reference for healthcare IT professionals and the primary study resource for CAHIMS and CPHIMS certification. Each post paraphrases the term in plain language, grounds it in real-world healthcare IT context, and adds a bedside nursing perspective you won’t find in a textbook.
📖 The Term: MACRA (Medicare Access and CHIP Reauthorization Act of 2015)
Source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025)
🔍 Plain-Language Definition
MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, is the federal law that changed how Medicare pays physicians and other eligible clinicians. Instead of paying mainly for the volume of services, Medicare now adjusts payment based on quality, cost, and the use of health IT, or rewards clinicians who join payment models that share financial risk.
The HIMSS Dictionary summarizes MACRA as making three major changes to Medicare clinician payment, which together created the Quality Payment Program (QPP). MACRA ended the Sustainable Growth Rate (SGR), the formula Medicare had used to set physician payment updates. It established a framework that rewards better care rather than more care. And it combined several existing quality programs into one, to measure clinician quality while cutting duplicate reporting. The Dictionary explains that eligible clinicians participate in one of two paths: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (Advanced APMs).
MACRA was signed into law on April 16, 2015, and the Quality Payment Program’s first performance year was 2017.
| QPP Path | How It Works | What Clinicians Need |
|---|---|---|
| MIPS | Clinicians receive a score that leads to a positive, neutral, or negative Medicare payment adjustment | Performance data across four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability |
| Advanced APMs | Clinicians who participate enough in qualifying risk-bearing models can be excluded from MIPS | Participation in a model that uses certified EHR technology, ties payment to quality, and carries meaningful financial risk |
| MIPS Value Pathways (MVPs) | A newer MIPS reporting option built around a specialty or condition | A connected set of measures and activities relevant to the clinician’s practice |
⚠️ Exam Alert: MACRA is the law. The Quality Payment Program is the CMS program it created. MIPS and Advanced APMs are the two participation paths. Promoting Interoperability is a MIPS performance category that carried forward the EHR use requirements of the HITECH-era Meaningful Use program for clinicians. Do not confuse MACRA with the Affordable Care Act or with HITECH, although all three push toward value-based care and health IT use.
🌐 Why It Matters: Real-World Healthcare IT Context
Before MACRA, Medicare physician payment updates were tied to the SGR formula, which repeatedly called for steep cuts that Congress overrode year after year. MACRA replaced that cycle with predictable updates and a structure that links payment to performance.
For health IT teams, MACRA made data a financial asset. MIPS quality measures are often reported as electronic clinical quality measures pulled from EHR data. Promoting Interoperability measures track activities such as electronic prescribing, health information exchange, and patient electronic access. Improvement activities include care coordination, patient engagement, and population management work. Cost is calculated by CMS from claims.
The Advanced APM path ties MACRA to broader value-based care. Accountable Care Organizations in qualifying tracks, along with other CMS Innovation Center models, require participants to use certified EHR technology and accept financial accountability for quality and spending. Those models depend heavily on analytics, care management tools, and data exchange.
MACRA has its critics. Policy advisors and clinician groups have argued that MIPS is complex, burdensome to report, and only loosely connected to meaningful improvements in care. CMS has responded with changes such as MIPS Value Pathways, and the program continues to evolve through annual rulemaking.
Common MACRA challenges for organizations:
- Quality measures that depend on documentation in specific structured fields
- Reporting burden across many clinicians and specialties
- Data captured in free text that measure logic cannot find
- Keeping up with annual changes to measures and scoring rules
- Small practices with limited staff and analytics resources
- Aligning clinicians who report through different paths or groups
What successful organizations do:
- Build measure capture into normal clinical workflow
- Monitor quality dashboards throughout the year, not just at reporting time
- Assign clear ownership for each performance category
- Use certified EHR functions for e-prescribing, exchange, and patient access
- Train clinicians and staff on why specific documentation matters
- Evaluate APM participation as part of a long-term value-based strategy
🏥 The Nurse’s Perspective: Clinical, Bedside, & Workflow
MACRA is often described as a physician payment law, but nurses influence its results in several ways.
At the Bedside
Many MIPS quality measures depend on information nurses collect. Screening results, vital signs, medication reconciliation, tobacco use, fall risk, and patient education are often documented by nurses and medical assistants during intake. When those items are recorded in the structured fields the measures expect, the organization gets credit for care that was actually delivered.
Advanced practice registered nurses are directly involved. Nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists are among the clinician types eligible for MIPS, so their own documentation and reporting affect their Medicare payments.
In Clinical Workflow
In practices and health systems participating in APMs, nurses often serve as care managers. They follow up after hospital discharges, coordinate transitions, manage chronic disease registries, and close care gaps, such as missing screenings or vaccinations. That work is central to performance on both quality and cost.
Health IT supports this work through registries, care gap alerts, outreach lists, and dashboards. Nurses who understand which measures matter can help prioritize outreach and make sure completed care is documented where it counts.
In EHR Implementation (Go-Live Perspective)
During an Epic Go-Live, quality measure capture is often built into intake forms, best practice advisories, and order sets. Nurses may notice prompts for screenings or documentation items that seem administrative, but many of them feed quality reporting programs such as MIPS.
At-the-elbow support analysts can help by showing clinicians where measure-related documentation belongs. After Go-Live, quality teams compare early measure performance with historical results to find workflow gaps, such as a screening documented in a note instead of the structured field the measure reads.
🎓 CAHIMS / CPHIMS & HIMSS Perspective
CAHIMS Exam Domain Mapping
MACRA is a core policy topic on the CAHIMS exam:
| CAHIMS Domain | How MACRA Appears |
|---|---|
| Healthcare & Technology Environments | Medicare payment reform; QPP; MIPS and Advanced APMs; relationship to HITECH and value-based care |
| Clinical Informatics | Measure capture in clinical workflow; care management; quality dashboards |
| Healthcare Information & Systems Management | Electronic clinical quality measures; certified EHR technology; reporting data pipelines |
| Management & Leadership | Payment strategy, APM participation decisions, performance monitoring, reporting governance |
Key Terms to Know Alongside MACRA
- Quality Payment Program (QPP) — the CMS program created by MACRA to reward value in Medicare clinician payment
- MIPS (Merit-based Incentive Payment System) — the QPP path that scores clinicians on quality, cost, improvement activities, and Promoting Interoperability
- Advanced APM — a payment model that uses certified EHR technology, ties payment to quality, and requires more than nominal financial risk
- Promoting Interoperability — the MIPS category focused on meaningful use of certified EHR technology
- Sustainable Growth Rate (SGR) — the former formula for Medicare physician payment updates that MACRA repealed
- Electronic Clinical Quality Measure (eCQM) — a quality measure calculated from structured EHR data
HIMSS Organizational Position
HIMSS engages with CMS on payment and quality policy, including the Quality Payment Program and Promoting Interoperability requirements, through its public policy and advocacy work. Members can find related education and research on value-based care and quality reporting through the HIMSS Resource Center.
🔗 Explore Further: External References
- CMS — MACRA: MIPS and APMs https://www.cms.gov/medicare/quality/value-based-programs/chip-reauthorization-act
- CMS — About the Quality Payment Program https://qpp.cms.gov/get-started/what-is-qpp/about-qpp
- CMS — QPP Ways to Participate https://qpp.cms.gov/eligibility-participation/ways-to-participate/overview
- CMS — Alternative Payment Models in the QPP https://qpp.cms.gov/eligibility-participation/apm/overview
- MedPAC — Medicare Payment Advisory Commission https://www.medpac.gov/
- HIMSS — Public Policy and Advocacy https://www.himss.org/public-policy-advocacy-overview
Term source: HIMSS Dictionary of Health Information and Technology Terms, Acronyms, and Organizations, 6th Edition (2025). All definitions in this series are paraphrased for editorial purposes. Readers are encouraged to consult the primary source for exact language.
Eric Andrew Kristof, RN, CAHIMS is a Healthcare IT professional and HIMSS Arkansas Chapter member based in Hot Springs Village, AR, with hands-on Epic Go-Live experience and a diverse healthcare and IT background. He writes at kristof.org at the intersection of clinical care and healthcare technology.
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