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This article highlights a significant issue that will change the landscape of the US healthcare for decades to come: the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of April 2015 (MACRA).1 MACRA heralds a rare opportunity for the US healthcare delivery system to revamp the way it reimburses physicians, with a pivot from a volume-based payment system to one of quality and value. MACRA essentially is designed to reward or penalise physicians for patient care services that have been provided. This legislation established the Quality Payment Program (QPP) which is the overarching term for the two tracks through which Medicare payments would be made: merit-based incentive payment system (MIPS), and advanced alternative payment models (advanced APMs).2 The QPP aims to improve health outcomes, promote smarter spending, minimise burden of participation, and provide fairness and transparency in operations.3 It replaces Centers for Medicare & Medicaid Services legacy programmes for clinician quality reporting, including the physician quality reporting system (PQRS), the value-based payment modifier (VBPM), and the Medicare Electronic Health Records (EHR) Incentive Program for Eligible Professionals, to support the transition to value-based care and healthcare delivery system reform.3–6 Physicians and other providers are critical to the success of MACRA.7 …

Family medicine and physician reimbursement: a US perspective and the RCGP International and Overseas Network