3 unintended consequences of MACRA


As physician practices get ready for the upcoming implementation of MACRA, many have a huge learning curve in front of them.

There’s still a lot of unease about the final rule to implement the Medicare Access and CHIP Reauthorization Act of 2015, which will determine how clinicians get reimbursed under the Medicare program. “I would argue that for doctors, it will be much bigger than Obamacare,” Michael Ivy, M.D., chief medical officer for Bridgeport Hospital in Connecticut, told NEJM Catalyst.

There a consensus that the law is here to stay, since MACRA had bipartisan support. “There is a really strong commitment to the program,” said Andrew Slavitt, acting administrator of the head of the Centers for Medicare & Medicaid Services, on a call with physicians last month. MACRA also replaced the onerous Sustainable Growth Rate formula, which no one wants to go back to.


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While physician groups learn what is required under MACRA, the new law may have some unintended consequences, according to the article.

  • It may force the merger of smaller practices into larger ones or encourage further acquisition of practices by hospitals and healthcare systems.
  • It may mean physicians drop out of Medicare or choose to get out of medicine entirely. Doctors with only a few years left in their careers are retiring earlier, particularly those who don’t want to be employed by large systems.
  • It may mean too great a reliance on electronic health record vendors to report data through MACRA. If there are errors in the data, practices could see negative reimbursements.

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