More acronyms, more pain: MACRA


More acronyms, more pain: MACRA


Larry E. Patterson, MD

Last year many rejoiced when the Medicare Access and CHIP Reauthorization Act (MACRA) became law. The revelers rejoiced because MACRA jettisoned many abominations, especially the SGR, an annual calculation that was always held hostage for some nonsensical, incoherent political reason.

But, on April 27, 2016, CMS released its 962-page proposed rule on how MACRA would work. (Imagine — a new government program explained in less than 1,000 pages!) The nano-synopsis: Besides MACRA, you will learn about MIPS (merit-based incentive payment schedule) and APM (alternative payment models). These new acronyms will soon become familiar as HIPAA, COBRA and DNR. Granted, as ophthalmologists we don’t use DNR much, but by the 950th page we might say, “Where do I sign?”

The celebrators revel in the thought of us earning our keep based on the quality of our work, and love that everyone will be working together. Visions of patients and staff singing “Kum Ba Yah” around a roaring campfire are filling my head.

All well and good. But sometimes with the government, for every action, there’s an unequal and terribly opposite reaction.

It’s way beyond the scope of this short missive to explain all 962 pages. For now, let’s say there are two tracks: MIPS, where most of us eye-folk will likely end up, is the track that allots the top groups a bonus; the middle folks will get a salary, and the bottom dwellers penalties, based on “merit.” There will be no badges, but this will include reporting on six measures, EHR usage, “clinical practice improvement activities” and showing cost savings. Your payment will be based on how you have performed compared to others. Penalties could eventually reach 9%. Excited? I know I am. The other track, APM, involves larger cooperative models, but as to how it would work for our specialty, no one seems to know.

What’s important for you to know is this: While MACRA doesn’t affect your payments until 2019, your performance affecting these payments starts in 2017! That’s right — your practice has only six months left to prepare for a new system whose regulations have only been introduced, and who knows when they will be finalized!

The whole purpose of MACRA is to gradually move physicians away from fee-for-service Medicare. And as with all things CMS, the overreach doesn’t stop with Medicare patients. The data must be submitted for all patients. Smaller practices could feel the impact of this decree the hardest, as they struggle to meet these new reporting requirements. Will they die off?

Physician burnout is at an all-time high, in large part due to increasing government mandates. The joy once felt has been siphoned off by nonelected, nonphysician bureaucrats, big-box medicine and lack of human interaction.

You have until June 27 to comment at Have a great day! OM