Physician leaders still have an opportunity to shape MACRA implementation

Emergency room doctor physician stethoscope scrubs Getty/gordonsaunders

Medicare's plans for a new physician payment system offers doctors a better alternative to the widely unpopular sustainable growth formula, but physician leaders need to speak up in order to help shape the proposed law into a more effective vehicle for payment reform, write two health policy experts in the Journal of the American Medical Association.

Jeffrey D. Clough, M.D., and Mark McClellan, M.D., Ph.D., describe the objective of the Medicare Access and CHIP Reauthorization Act (MACRA) as a "historic and complex undertaking." But they also identify uncertainties surrounding the rule, including the practical effect of the reforms on care quality and the questions surrounding the optimal path for different types of physicians under the rule. Small practices are especially concerned with the implications of the proposed rule.

The authors recommend:

  • Professional organizations focus on generating better tools to measure utilization and quality for the Merit-Based Incentive Payment System (MIPS), in which most physicians will initially participate under MACRA. Improved tools should provide "a foundation for greater opportunities to improve care while reducing overall costs, and a pathway toward APMs [alternative payment models] that is not clear for most clinicians today," write the authors.
  • Physicians should develop effective advanced APM models that offer opportunities outside the current options, which are limited to accountable care organizations or medical home demonstrations, neither of which offers a comfortable place for primary care doctors uninterested in a fully consolidated practice.
  • Physician organizations must continue to provide comments and leadership to guide and shape MACRA's implementation on a foundation of high-value, quality care.

To learn more:
- read the article