Here’s what physicians are saying about new MACRA payment system


What doctors think about the government’s overhaul of Medicare’s payment system for physicians depends on who you ask.

Many physicians, however, still have lots of questions about the reimbursement system unveiled by the Centers for Medicare & Medicaid Services over a week ago to implement the Medicare Access and CHIP Reauthorization Act (MACRA).

One doctor, who calls the final rule “a 2,398-page leviathan, glutted with bureaucratic blather,” wonders why physicians aren’t questioning the legality of the rule that implements MACRA. The law that established the Medicare program in 1965 stipulates that the government will not interfere in the practice of medicine, writes Louis P. Kartsonis, M.D., an ophthalmologist in San Diego, in Medical Economics.

“MACRA, with all of its distractions and fool’s errands, not only interferes with the way we practice, but threatens our compensation if we don’t get with the program,” says Kartsonis. “This is a flagrant violation of the Medicare law.”

He wonders why the medical establishment isn’t challenging the law in federal court and having lobbyists knock down doors on Capitol Hill. While Kartsonis says the new law will further hurt the doctor-patient relationship, other physicians have their worries, too.

Cliff Black, M.D., a bariatric surgeon in Annison, Alabama, who estimates about 30 percent of his patients are enrolled in Medicare, is worried about how the government will assess medical practices’ quality and efficiency, according to The Anniston Star. “They’re talking about a reduction in payments for failing to meet standards, but how do you assess that--what metric do you use?” Black asked the publication. “And there’s a lot of flippant interpretations of what they’ll pay.”

Another doctor in Anniston, Todd Scarbrough, M.D., a radiation oncologist, told the newspaper he did not think the new requirements would be that difficult. “We’ll just have to pay more attention to what we do,” he said, such as how often patients receive treatment and demonstrating they get proper quality of care. “But it is a slightly greater bureaucratic level on physicians.” But like Kartsonis, he is doubtful the changes will lead to a greatly improved quality of care.