Risk of 'Mass Exodus' of Doctors from Medicare New law's success or failure will 'profoundly influence the future of the U.S. health care system'

by John S. O'Shea, M.D. | Updated 21 Oct 2016 at 9:22 AM

In what may be the most significant modification to Medicare since the program began in 1966, on Oct. 15, the Centers for Medicare and Medicaid Services (CMS) released the final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It dramatically changes how Medicare pays doctors for their services.

Does it really matter how doctors get paid? Yes — the success or failure of the new payment system will profoundly influence the future of the U.S. health care system. And while the goals of MACRA are laudable, its implementation carries a number of unknowns and the potential for unintended consequences — for patients and doctors alike.

One recent survey of physicians found nearly 40 percent expect a "mass exodus" from Medicare over MACRA.

Before MACRA, Medicare used a fee-for-service payment system, reimbursing separately for each individual service provided, without regard to the quality of the care. The new system will reward doctors for providing high-quality, efficient care that leads to better patient outcomes, and penalize those who fail to do so. At least — that's the idea.