The “Madness” That Is MACRA/MIPS

Submitted by hci3-usr on Friday, May 27, 2016 - 04:28

Newtown, CT – May 27, 2016

“This may sound cynical, but there are probably only two rational choices for clinicians going forward – become a salaried employee delivering clinical care or become a hospital-based clinician exempted from the madness.”

Dr. John Halamka, CIO, BID Boston

In a recent post, John Halamka reviews the “madness” that is MACRA/MIPS as interpreted by CMS in its proposed rule. And it is truly madness. There are so many twists and turns, negations of current activities, wanton abandon of progress on current fronts, command and control of clinician activities that, either those who wrote the rule are hopeful of getting incredibly lucrative consulting contracts in 6 months, or they’re fanatics who feel that where CMS’s voluntary push to get all physicians into ACOs failed, the inextricable rule maze of MACRA/MIPS will force them there. Or maybe they’re both. Either way, it’s time to go back to Congress and ask for a pause.

What this means to you – It’s a mess. Some of the rules embedded in MACRA/MIPS would make the conversion to ICD-10 feel like a leisurely walk in the park on a sunny Saturday afternoon. Most of the current Medicare alternative payment models aren’t “advanced” enough to exempt physicians from MIPS and would have to be substantially changed. As such, payers and providers that flocked to these models will now have to back-track waiting for some additional guidance on what criteria would be sufficient to gain that “advanced” status. The uncertainty that this rule making has already wrought is astounding and there are myriad details that still need to be worked out. Given the lame-duck status of this Administration and the stakes involved in the implementation of this law, Congress should put the whole thing on pause, wait for the next Administration to come in, and then proceed. There’s no question here that the intent of MACRA/MIPS is good. It continues the inexorable move away from straight fee-for-service payments and cements the current shift. I would argue that the shift has now been cemented, and what we have to be careful of is the rushing of rules that may have a potentially devastating effect on the practice of medicine and on patients. There’s really no reason to rush and there are many many good reasons to proceed with caution, deliberation, a better understanding of unintended consequences, and a healthy dose of common sense. None of these is present in the proposed rules, and that’s the madness that John and many others are referring to. So let’s put a stop to that madness before we all have to pay a heavy price for it.


Francois Sig


Francois de Brantes
Executive Director