Congress Should Replace Medicare’s Merit-Based Incentive Payment System

Health Affairs February 26, 2018
Matthew Fiedler, Tim Gronniger, Paul B. Ginsburg, Kavita Patel, Loren Adler, Margaret Darling

In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) on a strong bipartisan vote. In addition to repealing the Sustainable Growth Rate formula that was used to set the level of physician payment rates, MACRA changed the structure of Medicare physician payment in ways intended to encourage clinicians to deliver more efficient, higher-quality care.

MACRA envisioned a long-run transition away from fee-for-service payment toward so-called advanced alternative payment models (APMs), models in which providers bear financial risk for the overall cost and quality of the care they deliver, driven in part by bonuses MACRA created for participation in such models. In the near term, however, most clinicians will participate in MACRA’s Merit-Based Incentive Payment System (MIPS), a...

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