MACRA: Big Fix or Big Problem?

In January 2017, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) took effect, ushering in a new system for physician payment in Medicare. With MACRA, policymakers ended the Sustainable Growth Rate (SGR) method for updating physician fees in Medicare and provided a permanent “doc fix,” relieving Congress of its annual duty to override substantial fee cuts that the SGR would have imposed. In place of the SGR, MACRA instituted the Merit-based Incentive Payment System (MIPS), which intends to reward clinicians for providing higher-quality and lower-cost care.

Under the MIPS, the performance of providers (individuals or groups) is assessed in 4 domains: quality, clinical practice improvement, advancing care information, and resource use (1). Poor performers receive negative adjustments to their Part B reimbursement rates, and high performers receive upward adjustments. If the adjustments are implemented as legislated, the MIPS will introduce wide variation in physician payment rates within the next 5 years (Table)...