Is MACRA Ruining Healthcare?

If you watch social media, physician forums or other places physicians gather, you’d be sure to hear complaining about MACRA and it’s partner in crime MIPS. Some are even still complaining about things like meaningful use and PQRS even though those have all been rolled into MACRA/MIPS now. At the end of the day, I don’t know a single doctor that likes MACRA and MIPS.

I take some of this with a grain of salt because I don’t know a single doctor who likes charting a patient visit either. This was true in the paper chart world and is just as true in the EHR world. Why would a doctor find joy in recording data from a patient visit? That’s like asking a lawyer if they like writing really long legal briefs or contracts full of legalese. We’d all rather just do the fun parts of our job. In medicine that’s seeing the patient, treating the patient, etc.

Charting will never be seen as fun, but doctors do it because it’s necessary to get paid. Although, this oversimplifies it. Doctors are amenable to charting the patient visit because having that information could help them at a future visit. Having a record of what happened at various visits is useful to the doctor the next time you come to see them. So, between reimbursement and continuity of care, there are clear benefits to why a doctor needs to record the visit.

This is the real problem with MACRA and MIPS. There’s no clear benefit to doctor for participating in MACRA and MIPS. At least with meaningful use there was a clear $44k payment that they’d receive. MIPS is much more nebulous and it’s revenue neutral so doctors really don’t know how much they’re going to be paid for participating.

Certainly, there are a whole lot of other nebulous reasons why a doctor should participate including physician reputation damage, lower provider compensation, diminished practice value, and even the ability to obtain and maintain loans. Some of these are going to hit doctors in the face and it’s going to hurt. However, most practices aren’t thinking in these terms. It takes a pretty wide vision to see all of these potential issues.

What about the clinical value associated with MACRA and MIPS? The studies haven’t really shown much clinical value. There’s a lot of hope around what could be done, but not any clear evidence of the benefits. Especially the benefits related to the specific MACRA requirements vs using an EHR generally.

All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice.

The challenge I have with this idea is that many blame MACRA and MIPS for everything that’s wrong with EHR use and implementation in healthcare. Let’s imagine for a minute that Congress was functional enough to pass a law that would get rid of all of MACRA. Then what? Would doctor’s problems be solved?

We all know that healthcare would still have plenty of problems. In fact, doing away with MACRA would do very little to alleviate the burden doctors are experiencing in healthcare today. They’d all celebrate MACRA’s death, but then they’d realize the impact would be pretty small.

I’m not suggesting that just because it would only have a small impact it shouldn’t be done. Healthcare got to where we are because we were unwilling or unable to make the incremental changes that would improve the healthcare system. Now the problems are so big and complex that they’re much harder to solve. I’m am suggesting that there are bigger fish to fry than MACRA.

That said, I would suggest an overhaul and simplification of MACRA. I’d suggest we take all the requirements and pass them through this question “What does this requirement do to improve patient care?” If this were the test, I think MACRA would look significantly different. In fact, it might mean that MACRA should really just be interoperability, ePrescribing, and a HIPAA risk assessment (which we could argue is already required by HIPAA). Imagine the value patients would get if we blew MACRA up and just replaced it with interoperability requirements which have no natural incentive in our current system. That’s something I think doctors could get behind.

At the end of the day, MACRA could be improved. It should scare us that very few doctors are fans of it. However, we also should be careful to not overstate MACRA’s impact on healthcare. There are plenty of other issues we have to deal with as well.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, 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, EXPO.health, 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.

2 Comments

  • I wouldn’t say MACRA is ruining healthcare, but it’s starting to drive the decision train, which may be the first step.

    From my corner of healthcare in America, our practice is forcing adherence to MACRA to set the tone for an ever growing portion of the workflow. The benefit from such is viewed as non-existent aside from protecting revenues. We have compliant doctors (with plenty of grumblings), but no happy ones that are doing this in the belief it’s good for medicine.

    Taking two parts of your post I think I can speak towards in view of that…

    “All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice.”

    They’re upset at the government because MACRA is seen as an intrusion with no benefit. At best, it’s a threat to their income (both to the business and their end of year salary), and at worst, they don’t trust the government entering the realm of “quality” which traditionally was limited to clinical relevancy. We’ve had plenty of internal discussions of how MACRA quality measures are worlds away from what the physicians view as truly important quality measures for their profession.

    “Let’s imagine for a minute that Congress was functional enough to pass a law that would get rid of all of MACRA. Then what? Would doctor’s problems be solved?”

    This doesn’t account for the primary reason MACRA was passed in the first place- controlling the costs of Medicare. They can talk about quality all they want, the government needed to eliminate the near automatic 2.5% (or thereabouts) increase in Medicare fee reimbursements. They do that with the freeze in rate increases, and making the physicians battle each other for what remains with the reward/penalty system.

    Congress will never get rid of MACRA, it’s their plan to keep Medicare costs from blowing up until 2025 as the boomer generation keeps adding to the rolls.

    So, MACRA is seen as having no benefit but a lot of downside in income and daily operations. About the only other thing that could have brought these emotions about would come from the IRS, but this is worse in some ways, as it’s forcing changes in clinical operations for the purpose of checking a box to protect income.

    Welcome to the new normal.

  • Yep.
    Count me as another mid career MD that sees the futility in any hope for the future of medicine. We are doomed. I do everything I can to talk everyone out of becoming an MD. Including my children. We have 100% of the accountability and zero authority. Worse I am penalized by our go ernment because I refuse to play stupid counting and clicking games. I was just discussing again (seems daily) my plans to exit this career. Too bad as I am one of only 4 orthopaedic surgeons left at our hospital. 20 years ago we had 35 on staff. Every single person on earth seems to be saying all this data entry by MDs is silly, inefficient, useless, complex and frankly a huge costly waste of time. Everyone is speaking to burdens and the ridiculous nature of all this forced mindless data entry, super complex reporting, terrible auditing and penalizing for no good reason. When we look back a decade from now and wonder how we made medicine like the postal service, I know I can say I did try to point out better ways. But no one listened. At all. If all these programs are so wonderful, tell me all the great things that have come out of MU, PQRS, VBM, QPP? So you got MDs to buy EHRs. Great. Everyone hates them. Great work. HITECH set back real IT innovation in medicine at least a decade. CMS touts patents over paperwork with absolutely no action, even worse, they made the MACRA program even more burdensome this year. AAPM, you want me to take even MORE risk, and hire more admins to run it? For 5%? Come on. I have finally come to realization, that medicine has been destroyed by administrators, CMS /ONC, regulators, bean counters and the dozens of people I support just trying to stay ahead of the complexity. Its like the movie Office Space when I forget to click something in the 1000 clicks I have to do a day, I get 10 admins telling me about my TPS reports on what I did wrong. What is really the worst part, is that I am pretty darned good at what I do, I am super busy and loaded with patients, too many. So I will be yet another MD, that has just had enough, that left the game in his prime. We should all be ashamed at what we did to our physicians.

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