MACRA: CMS Policy Nerd #Fail

One aspect perhaps not getting enough attention is how MACRA doubles down on price fixing for Medicare services. It’s price fixing coupled with increasingly complicated hoops to jump through; hoops that determine if a physician will get a small percentage more or less than the fixed price. But the costs and risks of jumping through the hoops far outweighs any potential gain for a solo physician. (It’s not really about paying physicians more anyhow but controlling costs under the guise of paying for quality.)

The CMS self-styled “innovation center policy nerds” think they are smarter than the free market at determining prices. They think they can create algorithms that somehow replace free market mechanisms to tie payment to value. The problem is that decades of Medicare payment policy developed by Medicare policy experts has resulted in one failure after another; flopped Medicare policies are actually responsible for divorcing payment from value. Why should we expect they are getting it right this time?

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One thought on “MACRA: CMS Policy Nerd #Fail

  1. “…guise of paying for quality”… is so true. I would go so far as to say it (VBP) pays for supposed surrogates of quality, which are really more processes and documentation requirements than measurable benefit to patients. As long as we heap the “quality” on patients, whether they are better or not and regardless of whether they like what we are doing or not, then in the eyes of CMS we have created value.

    Unfortunately, as it all unfolds in years to come it will indeed be a fixed pie or zero sum game. As one doctor benefits financially, another necessarily must lose. It will come down to fractions and decimals and a lot of “chartsmanship”. Those that document the best and are skilled at the game will win.

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