MACRA good in theory but won’t improve outcomes, two academics say

Are policymakers wrong that MACRA and other pay-for-performance initiatives will improve health outcomes by providing doctors with financial incentives to meet quality measures? Two academics think so.

While paying doctors incentives to improve better health outcomes for patients sounds good in theory, it doesn’t actually work, Stephen B. Soumerai, a professor of population medicine and research methods at Harvard Medical School, and Ross Koppel, who teaches research methods and statistics at the University of Pennsylvania, write in Vox. They dispute economists and studies that appear to support pay-for-performance models.

“Health professionals do not respond to economic carrots and sticks like rats in mazes,” say the two professors.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the new Medicare payment system for doctors that kicked off January 1, won’t improve health outcomes, they say.

“Economists argue that such financial incentives motivate physicians to improve their performance and increase their incomes. In theory, that should improve patient outcomes. But in practice, pay-for-performance simply doesn’t work,” they say. Their argument is supported by a new study in which researchers did a systematic literature review and found pay-for-performance programs did not improve health outcomes.

The model may even do harm, as doctors may decide not to take on the sickest patients who need the most care because they could have a negative effect on quality scores that will determine their payments, the two professors say.

Instead of pay-for-performance, policymakers should try and identify the reasons for poor performance, they say, as doctors and other healthcare professionals would welcome concrete information they can use to improve care and save money.