- Fewer than 10% of providers will be able to participate in alternative payment models, one of the pathways, which abandons the fee-for-service model, healthcare policy experts argued in a Health Affairs blog post.
- The Medicare Access and CHIP Reauthorization Act (MACRA) introduces two main pathways for physician payments in an attempt to shift away from the traditional FFS payment models.
- MACRA has the potential to hold providers accountable for quality and cost while also giving them greater flexibility in how they practice, but the proposed rule does not provide clear guidance, the authors wrote.
MACRA will likely dole out more than $1.2 billion in bonuses and penalties affecting up to 836,000 providers in its first year, according to authors Mark McClellan, Frank McStay, and Robert Saunders. However, a lack of details in the proposed rule leaves many providers, particularly those in smaller practices, wondering what exactly the payment reforms mean for them.
Alternative payment models (APMs), one of the payment pathways being implemented by MACRA, will provide a 5% bonus to certain participating providers. However, these participating providers will likely be limited to some accountable care organizations (ACOs) and providers in the Comprehensive Primary Care Plus (CPC+) pilot.
Most providers, particularly smaller practices and solo practitioners, will receive payment through the Merit-Based Incentive Payment System (MIPS). Most of these, around 90% of solo practitioners and 70% of small practices, will be penalized under MACRA compared with just 20 percent of larger practices.
CMS acting Administrator Andy Slavitt has maintained that physicians in solo and smaller practices will be able to do just as well as those in larger practices. In June, HHS announced a five-year funding initiative of up to $100 million to provide these practices with education and training in preparation for MACRA.
As a result of the way payment reforms are currently structured, they could help to accelerate the trend toward provider consolidation, the Health Affairs authors argued. While larger provider organizations should reduce costs through better coordination and sharing of fixed costs, their ability to negotiate higher prices with payers often drives costs upward.
“The law holds great promise in giving clinicians more flexibility in how they practice while in return requiring more accountability for quality and cost,” the authors said. “Fulfilling that promise, while avoiding undesirable effects such as price-increasing consolidation, requires further work.”