NEJM January 18, 2017
Eric C. Schneider, M.D., and Cornelia J. Hall, A.B.

Medicare is poised to overhaul the way it pays for ambulatory care services. The Centers for Medicare and Medicaid Services (CMS) has published a final rule codifying the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),1 which directed CMS to gradually replace fee-for-service reimbursement with value-based payment approaches. MACRA’s bipartisan passage may position it to play an outsized role in federal efforts to improve health care quality, rein in service volume, and control spending growth while not jeopardizing access to care. Can it deliver on these goals?

MACRA’s influence on Medicare spending may be substantial. Medicare Part B paid $70 billion for physician services in 2015,2but the referrals, orders, and prescriptions of ambulatory care physicians drive much of Part A...

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