Docs will be ‘livid’ when they find out MACRA pays them less, analyst predicts

Money

Physicians may end up with less in their pockets under the government’s new Medicare payment system, several analysts predicted Thursday.

The Medicare Access and CHIP Reauthorization Act (MACRA) will create a ‘payment gap’ for doctors that will only grow, said one analyst at a briefing sponsored by the Brookings Institute and the American Enterprise Institute (AEI), as reported by MedPage Today. The briefing was held to discuss the annual Medicare trustees’ report released by the Obama administration this week that looks ahead at Medicare funding.

Some of the think tank experts said physicians are likely to be hurt by MACRA, which replaces the sustainable growth rate reimbursement formula for physicians.

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"Doctors are going to be livid when they absorb the fact that they spent so much political capital to enact MACRA only to find out ... that under the current payment system, doctors are going to get paid less; that gap will grow over time," said Robert Moffit, Ph.D, senior fellow in the Center for Health Studies at the Heritage Foundation, according to MedPage Today. "When they absorb that fact, I think we're going to see more trouble on Capitol Hill over physician payment."

Under MACRA, physicians will be in either an alternative payment model (APM) or in the Merit-based Incentive Payment System (MIPS). They will either get a 0.75 percent or a 0.25 percent payment rate update each year, regardless of the inflation rate, Paul Stipalnic, Medicare’s chief actuary, said at the briefing. The Medicare Economic Index is expected to increase at 2.2 percent for physicians, so the payment rate will create a gap in how payment rates will increase relative to physician’s costs, he said.

However, payment updates do not include the bonuses that physicians will be eligible to receive based on their quality scores, which can be as high 9 percent under MIPS and 5 percent under the APM program. Under the proposed rule to implement MACRA, the vast majority of practices will fall under MIPS, as FiercePracticeManagement reported this week.

Another analyst, James Capretta, a senior fellow at the Ethics and Public Policy Center at the AEI, called MACRA “a gigantic illusion” that will need a massive revision down the road. He said he does not see how a system where the federal government will be able to rank every physician on quality metrics starting in 2019 and pay them according to their score is going to work in a way physicians find acceptable.

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