The Future of MACRA – MACRA Monday

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

As mentioned in my previous MACRA Monday post, MACRA was a hot topic at the HIMSS 2017 conference. No doubt it was on pretty much everyone’s minds. A few people I talked to said that there’s an insatiable appetite for MACRA related content and they’re right. It’s amazing how many people still need to learn about MACRA and how many who know the basics still need to get into the nitty gritty. I loved one tweet from the conference that said that the line to the CMS booth was longer than the line for ice cream which is saying something.

Despite all this interest in MACRA, there is a growing rift in how organizations and doctors are approaching MACRA. There seems to be universal hatred of MACRA by doctors. I have yet to find a doctor out there that likes MACRA. The best I’ve found is doctors who don’t like it but don’t have a major issue with it either. If there’s a practicing doctor out there that likes MACRA, I’d love to meet you.

On the other hand, I don’t know a single large organization that is planning to opt out of MACRA. Every organization I’ve talked to is planning to participate in MACRA in some shape or form. They usually argue some mix of the following reasons for their participation:

  • We can’t take the penalties to our reimbursement.
  • The incentives are relatively small, but across 100s of providers that’s a big chunk of change.
  • What happens to our doctors when the MACRA results are put on the physician compare website? We don’t want to take the reputation hit.
  • This is just the start of these programs. If we opt out of them, we’ll just be behind in the future.

These large organizations are going to participate. I just don’t see them with any other options. Plus, if I were being really cynical I would say that a new administrative program from the government is great for administrators’ jobs.

One regular reader of this site, meltoots, makes this passionate plea from the doctor perspective:

You know me John,
CMS is completely unaware of how bad it is out here on the front lines. MACRA is dead. They can try to implement, but it will fail. The front liners that are left have had enough of the fraud of reporting “quality” as a measure of success. Does not work at all. Its a sham. ACOs failing left and right. Does CMS REALLY think that if i report a 100% preop antibiotic rate is quality? We do that 100% already. Do they really think that CPIA is “value” or is it just reporting “value”. Lets get real. All the small practice incentives are going to 11 companies, NOT the actual practices. For “education” and “training” on MACRA. Thanks. Right. There is a HUGE disconnect between CMS/HIT and front line MDs. Again this week 2 more people gave up medicine in our hospital. I’m telling you this is a crisis and cannot be ignored. Its time to unburden MDs from all these distractions, let EHR companies innovate without being shackled to cert requirements. Wash DC cannot solve this. They have set us back 10 years already. Time let go and get out of the way.

The problem is that I think he’s missing the point. CMS does think that MACRA will improve quality. Trying to illustrate that you disagree is likely going to fall on deaf ears.

The comment about MACRA being dead could be taken a lot of different ways. However, I can assure you that it is not dead and not even showing signs of death. Doctors can complain and moan all they want, but if they don’t get their large practice colleagues on board as well, then MACRA will not only survive, it will thrive when it comes to participation numbers.

I personally think that the battle to kill MACRA is a waste of effort since it will likely never happen. Instead, doctors should focus their energy on improving MACRA so that it’s simplified and focused on things that do improve healthcare. Sure, it will never get their 100%, but the all or nothing approach to trying to kill MACRA will likely lead to even worse results (ie. wasted energy and no changes).

What do you think about the future of MACRA? I look forward to hearing your thoughts in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Concur MARCA isn’t going anywhere. If you look at the legislative track it took, only things like non-binding resolutions in support of Little League Baseball sail through Congress quicker.

    It’ll get tweaked- probably to ensure there is a real bell curve once CMS realizes too many groups/providers are clustered at the top on quality reporting- but it’s going to stay in place as a whole. The govt found a way to make the wolves fight over supper with regard to Medicare payments, and for a group/practice that is left wanting, they’ll simply be told “get better and you’ll get more money.”

    Would love to see some breakouts on how MACRA can be analyzed/actioned at specialized practices. As a admin support staffer for a Radiology group, we had the most ambiguity unpacking how our unique specialty will be treated, especially for ACI and the available waivers. I’m sure others across the specialty provider spectrum are scratching their heads.

  • We are just now instituting all the “quality measures” in our system. Please John, just come and follow me for ONE day and see what those of us on the front line of medicine have to put up with. It doesn’t help patients and it doesn’t help us. It helps large systems improve their reimbursement and bean counters get to smile and feel better that they are “making a difference” somehow in patient care.

  • meltoots,
    Your words are now marked in this blog post.

    I agree. I need to dive into the specialty specific options a bit more. That would be a good thing. I’ll see what I can do.

    I’ve actually seen many doctors, but I’d love to come by your office. Looks like my sister is pretty close to you, so next time I visit her I’ll come say hi. Just to be clear, in this post I’m not arguing that MACRA should go forward and I’m not arguing that it’s having an impact for good. I’m just saying that I don’t see it going anywhere. In fact, I think I insinuate that you and I are mostly on the same page.

Click here to post a comment