MACRA 166The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the sustainable growth rate (SGR) formula. It also replaces existing quality programs with the Quality Payment Programs (QPP) in which physician payments will be based on participation in one of two pathways: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). These programs reward physicians based on performance data and taking part in new payment and delivery models.