Medicare’s “Doc Fix” Won’t Fix Much

Dallas, TX 

The “doc fix” contained in the Medicare Access and CHIP Reauthorization Act (MACRA) is fiscally irresponsible, and will only increase federal control over how doctors practice medicine, warns a new report by National Center for Policy Analysis Senior Fellow John R. Graham.

“Just one week ago, the Acting Administrator of the Centers for Medicare & Medicaid Services indicated that the new Medicare payment system for physicians would be delayed. Physicians and patients should not hope that it will go away for good,” warns Graham. “As with the federal imposition of Electronic Health Records in 2009, ‘delay’ just means more confusion, complexity, and compliance costs. For consumers, this translates to higher costs and more difficulties getting access to timely and quality care.”

Why won’t the “doc fix” fix anything? There are two major reasons MACRA is a poor solution:

  • It is not paid for. Less than 4 percent of the increased spending authorized by MACRA is offset by other government spending cuts. The result? An estimated $141 billion increase in the accumulated deficit over 10 years and $500 billion over 20 years.
  • It significantly increases federal control of the practice of medicine. Clinicians will face increasing requirements to comply with federal regulations in order to get paid. These regulations will likely include greater reliance on government-certified Electronic Health Records, which have already proven to frustrate doctors and do nothing to benefit patients care, despite an investment of $30 billion taxpayer dollars.

How can we make it better? There are some opportunities advocates of consumer-driven Medicare should recognize and advance:

  • Integrating Medicare Part D (prescription drug) claims into Medicare Part A (hospital) and Part B (physician) claims so the value added by prescription medicines to health care overall is adequately recognized.
  • Moving away from the Resource-Based Relative Value Scale to paying for “bundles” of care.

“Meaningful relief from this 962-page rule governing how physicians treat Medicare patients is highly unlikely, because the legislation backing it up was passed in 2015 with an overwhelming bipartisan majority in Congress,” says Graham. “Nevertheless, delay provides some opportunity to take a fresh look at how to improve Medicare’s physician payments.”

The “Doc Fix” Is In: An Initial Assessment of Medicare’s New Rule Over the Practice of Medicine: