News & Commentary

How physicians will fare under MACRA

A recent study in Health Affairs projects physician payment rates under MACRA, comparing them to what they would have looked like had MACRA not been passed. Researchers with Rand compared the two MACRA payment tracks that physicians will be able to choose from starting in 2019: the Merit-Based Incentive Payment System (MIPS), and the advanced alternative payment models (APMs). The two will replace the “widely reviled” Sustainable Growth Rate formula, which was intended to limit growth in Medicare spending. Instead, Congress overrode those cuts 17 times between 2003 and 2015 because the planned increases would have been so small that they might have forced many doctors to not accept Medicare patients.

Physicians who participate in MIPS would be eligible to receive plus or minus 4% reimbursement in 2019 and will possibly go up to 9% in 2022; bonuses for top performers may be increased by a factor of up to 3 until 2024. Physicians who are a part of an APM are qualified for a 5% incentive payment.

Projected Medicare physician payment rates under MACRA vs. a pre-MACRA baseline scenario, 2015–2030

Physician payment rate relative to 2015

Source: Hussey PS et al., Health Affairs, April 2017

By 2030, payment rates are expected to be 8% higher for physicians in the MACRA APM track. They’re expected to be 5% higher for physicians in the MIPS track, the study states.

Keep an eye on what happens in 2025, a pivotal year, according to the Rand experts, “one in which a confluence of policy factors are expected to significantly reduce physician payments, a situation reminiscent of the SGR.” Beginning in 2025, doctor payment rates in both the APM and MIPS tracks will fall below the projected pre-MACRA baseline.


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