The MACRA problem for physicians

Medicare is on steroids trying to base reimbursement for physicians tied to quality of care (value based payments) delivered despite there being no real empiric measures yet scientifically validated. The other object is to force closer cooperation with hospitals.

In the proposed rules (MACRA), physicians will have to bill under either merit based incentive based system (MIPS) or alternative payment model (APM). MIPS will probably apply to a majority of physicians and the first performance period when it will apply will be January 1st 2017 although the program goes into effect in 2019. The risk may be up to 4% the first year but could exceed 9% a year later. CMS says that about 761000 physicians will be eligible for MIPS and between 30,658-90,000 will be exempt from MIPS and be able to participate in APMs. MIPS components include: 50% for quality (PQRS & VBPM), 25% for something that will replace ‘meaningful use’, 15% for clinical practice improvement and 10% for cost.

Physicians will increasingly be held responsible for in-patient hospital spending!! The idea is that it is physicians who cause the hospital to spend the $! Although APM will have more flexibility, the standard for eligibility will be stricter than MIPS and necessarily involve being part of an ACO.


Is your head spinning with all the new acronyms? We will need to hire translators to understand the new language. Maybe we need to get together and form a consulting group to make all this understandable?