The year 2015 brought an end to the much-maligned Sustainable Growth Rate (SGR), sometimes known as the “doc fix.” The SGR established limits on Medicare reimbursement for physicians, and each year, physicians and those lobbying on their behalf were forced to stave off drastic cuts to their payments.
“The SGR was Congress’s attempt to control the rise of Medicare costs. It established a flawed formula that, if carried out, would have reduced reimbursements severely,” says Ed Herzig, MD, FACP, MACR, immediate past chair of RheumPAC, political action committee of ACR, and a rheumatologist at Mercy Health in Cincinnati. “We had to go to Congress every year, sometimes twice a year, and use our advocacy skills to get them not to [implement] it.”
Now, rheumatologists and others are working to understand and prepare for its replacement, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was passed on April 16, 2015. MACRA orients reimbursement toward paying for value over volume and relies on many of the quality initiatives CMS has pushed in recent years.
However, details on MACRA were lacking until April 27, 2016, when the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rulemaking.
At First Glance
“Initial review of the proposed rule suggests that CMS has been listening to the rheumatology community’s concerns about developing a value-based payment system that works to assist, not hinder, the ability of rheumatologists to deliver high-quality care to Medicare patients living with rheumatic diseases,” ACR President Joan Von Feldt, MD, MSEd, said in a statement following the CMS announcement.1
However, because MACRA fundamentally alters the way physicians are paid for the work they do, many remain uncertain of the impact it will have on the practice of medicine, particularly for rheumatologists.
“The stated purpose [of MACRA] is to improve quality and reduce cost,” Dr. Herzig says. “Improving quality is only theoretical, but what isn’t theoretical is reducing cost. CMS is taking a carrot-and-stick approach to cost savings. If practitioners reach certain defined goals [by the CMS], whether they are ‘quality’ or cost, then doctors will be rewarded.”
This perspective is echoed by Christopher D. Adams, MD, chief of rheumatology at East Alabama Medical Center in Auburn/Opelika, Ala., and a member of the ACR’s Government Affairs Committee, who says MACRA “is based on some good ideas, and the really good idea is that we should pay for quality and effective outcomes in medicine. The problem with MACRA is that it’s a one-size-fits-all mentality, and rheumatologists have argued for years that what we do is different from everyone else.”