MACRA: Big Fix or Big Problem?
Authors: J. Michael McWilliams
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions18 July 2017MACRA: Big Fix or Big Problem?J. Michael McWilliams, MD, PhDJ. Michael McWilliams, MD, PhDFrom Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0230 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Centers for Medicare & Medicaid Services. The Medicare Access & CHIP Reauthorization Act of 2015. Quality Payment Program. Accessed at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MACRA-NPRM-Slides.pdf on 21 April 2017. Google Scholar2. Neprash HT, Chernew ME, Hicks AL, Gibson T, McWilliams JM. Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Intern Med. 2015;175:1932-9. [PMID: 26501217] doi:10.1001/jamainternmed.2015.4610 CrossrefMedlineGoogle Scholar3. Baker LC, Bundorf MK, Kessler DP. Vertical integration: hospital ownership of physician practices is associated with higher prices and spending. Health Aff (Millwood). 2014;33:756-63. [PMID: 24799571] doi:10.1377/hlthaff.2013.12794 CrossrefMedlineGoogle Scholar4. McGuire TG, Pauly MV. Physician response to fee changes with multiple payers. J Health Econ. 1991;10:385-410. [PMID: 10117011] CrossrefMedlineGoogle Scholar5. Casalino LP, Gans D, Weber R, Cea M, Tuchovsky A, Bishop TF, et al. US physician practices spend more than $15.4 billion annually to report quality measures. Health Aff (Millwood). 2016;35:401-6. [PMID: 26953292] doi:10.1377/hlthaff.2015.1258 CrossrefMedlineGoogle Scholar6. Barnett ML, Hsu J, McWilliams JM. Patient characteristics and differences in hospital readmission rates. JAMA Intern Med. 2015;175:1803-12. [PMID: 26368317] doi:10.1001/jamainternmed.2015.4660 CrossrefMedlineGoogle Scholar7. Rose S, Zaslavsky AM, McWilliams JM. Variation in accountable care organization spending and sensitivity to risk adjustment: implications for benchmarking. Health Aff (Millwood). 2016;35:440-8. [PMID: 26953298] doi:10.1377/hlthaff.2015.1026 CrossrefMedlineGoogle Scholar8. McWilliams JM. Changes in medicare shared savings program savings from 2013 to 2014 [letter]. JAMA. 2016;316:1711-1713. [PMID: 27612292] doi:10.1001/jama.2016.12049 CrossrefMedlineGoogle Scholar9. Newhouse JP, McGuire TG. How successful is Medicare Advantage? Milbank Q. 2014;92:351-94. [PMID: 24890251] doi:10.1111/1468-0009.12061 CrossrefMedlineGoogle Scholar10. McWilliams JM. Savings from ACOs—building on early success. Ann Intern Med. 2016;165:873-875. [PMID: 27723870]. doi:10.7326/M16-1846 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.Disclaimer: The content is solely the responsibility of the author and does not necessarily represent the official views of the Laura and John Arnold Foundation or the National Institutes of Health.Grant Support: By grants from the Laura and John Arnold Foundation and the National Institute on Aging of the National Institutes of Health (P01 AG032952).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0230.Corresponding Author: J. Michael McWilliams, MD, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; e-mail, [email protected]med.harvard.edu.Author Contributions: Conception and design: J.M. McWilliams.Drafting of the article: J.M. McWilliams.Critical revision of the article for important intellectual content: J.M. McWilliams.Final approval of the article: J.M. McWilliams.Obtaining of funding: J.M. McWilliams.This article was published at Annals.org on 16 May 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMACRA: Big Fix or Big Problem? J. Michael McWilliams MACRA: Big Fix or Big Problem? J. 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