MACRA: Then and Now

By David Heller


How much do you know about Congress’ effort to “rein in” expenses associated with healthcare’s fee-for-service system with the passage of MACRA?

Incentivizing value-based care was the goal of the Medicare and CHIP Reauthorization Act of 2015, aka MACRA, writes David Heller of the EHRA Public Policy Committee and Corporate Counsel for Regulatory Affairs at Greenway in an article tracing MACRA’s policy roots and offering recommendations for its future in the American University Health Law and Policy Brief.

In the article, “MACRA: Emerging from the Thicket,” Heller explains some of the reporting complexities that the Congressional authors of MACRA were trying to address.

“[R]epresentatives had heard the numerous complaints from physician associations and technology vendors that the various reporting programs were too complex and burdensome…Congress addressed these concerns in [MACRA]… In addition to repealing the SGR, it created the Merit-based Incentive Payment System (MIPS). MIPS rolled PQRS, Meaningful Use, and the Value-based Modifier into a single reporting program…Medicare reporting would have one deadline and a single reporting portal. It would be regulated through a single regulatory stream rather than several. All in all, the purpose was to make reporting quality data to Medicare a simpler process.”

However, writes Heller, “Despite Congress’ intention to simplify MACRA and remove political uncertainty from physician payments, it has been poorly received to date.” Although there have been calls from many corners to replace MIPS with something simpler or voluntary, “given its bipartisan buy-in, and the general universal and bipartisan dislike for the fee-for-service system, it looks like MACRA is here to stay. But its success depends on the details of implementation and physician buy-in.”

Heller’s thoughtful article provides a detailed analysis of the past, present and future of MACRA, concluding with the recommendation that “lengthening the regulatory cycle, simplifying the requirements, and consistent implementation should underpin future rulemaking.”

Read the full article here.

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