With its Medicare Access and CHIP Reauthorization Act of 2015, CMS is promising to improve the healthcare system. Providers will be reimbursed by meeting or exceeding quality outcomes, which aims to bolster the care patients receive.
Ophthalmologist Kristin S. Held, MD, does not see MACRA as promising, but rather views the payment model as a way to control pricing. In the fall issue of the Journal of American Physicians and Surgeons, Dr. Held argues, "scoring and grading physicians through financial incentives and penalties in order to drive behavior would, in other contexts, be called bribery and extortion."
CMS intends to motivate physicians to provide quality care, but many small practices may not have the resources for success. A Medscape Medical News Survey found almost 33 percent of physicians in small practices predict MACRA will result in small practices merging into larger groups. Additionally, 59 percent of physicians in practices with less than 25 clinicians expect to receive a performance penalty as high as 4 percent under MACRA.
MACRA may also compromise patient privacy, Dr. Held argues. For instance, the new system mandates physicians cooperate with the Office of the National Coordinator for Health Information Technology and not block government access. Dr. Held says this access applies to patients' individually identifiable health information, and patients need not give consent for the ONC to gain access, thereby putting an end to patient privacy.
Dr. Held says, "Ultimately, private physicians cannot ethically comply with MACRA. If this rule goes forward as promulgated, many more physicians will opt out of Medicare and commercial insurance to pursue successful practice models, providing an alternative for patients, also."
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