Is MACRA Legal?

California physician questions “bureaucratic blather”

On October 14, the Department of Health and Human Services published its final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Writing in Medical Economics’ blog section, one doctor wonders why his fellow physicians aren’t questioning the legality of the rule that implements MACRA. According to Louis P. Kartsonis, MD, an ophthalmologist in San Diego, in the transition from fee-for-service to pay-for-performance, one question that has not been asked is whether MACRA is legal.

The rule, which Kartsonis describes as “a 2,398-page leviathan, glutted with bureaucratic blather,” empowers the federal government to regulate payments under Medicare and to change the way physicians care for patients. Physicians who don’t participate will be penalized with cuts to their Medicare reimbursements beginning in 2019.

Kartsonis points out, however, that the Medicare law was passed in 1965 with the stipulation that the government would not interfere with the practice of medicine. The relevant clause, titled Prohibition Against Any Federal Interference, reads as follows:

“Section 1801. Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.”

Kartsonis writes: “MACRA, with all of its distractions and fool’s errands, not only interferes with the way we practice, but threatens our compensation if we don’t get with the program. This is a flagrant violation of the Medicare law. So why isn’t the medical establishment challenging the legality of this morass?”

Sources: FierceHealthcare; October 24, 2016; and Medical Economics; October 22, 2016.