While many physicians are skeptical about MACRA, the new Medicare reimbursement system that began January 1, its success may depend on details that get hashed out in the next few years.
The government can take steps to improve the chances of success for the Medicare Access and CHIP Reauthorization Act, according to four researchers from the nonprofit RAND Corporation.
While the Centers for Medicare & Medicaid Services made substantial changes to its final rule implementing MACRA based on thousands of comments, many from physicians, “there is room for further changes during the rollout—and potentially strong interest in doing so from Tom Price, the physician nominated to lead the Department of Health and Human Services,” write Adam J. Rose, a natural scientist; Peter S. Hussey, a senior policy researcher; Monique A. Martineau, a communications analyst; and Mark W. Friedberg, a senior natural scientist.
With the rollout of MACRA, it’s important to avoid pitfalls that will only add to physician displeasure with the new payment system, they say. They recommend that the government:
- Make sure that payment mechanisms align with clinical rationales so practicing clinicians can see how they can benefit patients.
- Avoid operational errors, such as setting up a system to audit a percentage of cases to ensure correct payments are made to clinicians.
- Base risk adjustment on stratification by parameters, such as race or area-level poverty.
- Alleviate the administrative burden of performance measures. Physicians are frustrated by having to report many measures in slightly different formats to different entities.
While the RAND researchers are optimistic MACRA can succeed, Anish Koka, M.D., a cardiologist in private practice in Philadelphia, says physicians should just refuse to participate in the reimbursement system.
"Yes, there's a financial penalty at the moment for not participating, but I would strongly argue physician practices that focus resources on actually improving patient care will come out ahead in the short and long term,” Koka writes in Medical Economics.