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In Blog Post, Dr. John Halamka Rips Apart Proposed MACRA Rule

May 6, 2016
by Rajiv Leventhal
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In a blog post on Thursday, May 5, John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston, gave a very gloomy outlook on the recently released proposed Medicare Access and CHIP Reauthorization Act (MACRA) rule.

In terms of healthcare IT, the rule, released on April 27, creates a unified framework for physician reporting called the Quality Payment Program, which includes two paths for eligible Medicare physicians: the Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS, though they won’t be locked into one path or the other in subsequent years.

While MIPS allows Medicare clinicians to be paid for providing high value care through success in four performance categories—Quality, Advancing Care Information (the “new” meaningful use), Clinical Practice Improvement Activities, and Cost—advanced APMs include payment models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

On the evening of the rule’s release, Dr. Halamka, who recently stepped down from his longtime role as Health IT Standards Committee chair, and who is often looked at a go-to source for his thoughts on next-level health IT policy issues, had a mixed reaction to proposal from the Centers for Medicare & Medicaid Services (CMS), but did say that he applauds the newfound focus on outcomes and quality.

John Halamka, M.D.

However, a subsequent blog post from Halamka on May 5 had a different feel to it. Indeed, he took issue with the complexity of the rule, listing all of the requirements for eligible Medicare clinicians, and sarcastically adding, “Listening to each patient’s story, being empathic, and healing are optional.” He continued, “After spending 20 hours reading the MACRA NPRM [Notice of Proposed Rulemaking], I had one overwhelming thought. Sometimes when you remodel a house, there is a point when additional improvements are impossible and you need to start again with a new structure. The 962 pages of MACRA are so overwhelmingly complex, that no mere human will be able to understand them.”

Halamka further noted, “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.”

He wrote that CMS officials are smart and mean well with their intentions, but he doesn’t see how implementing the proposed rule into the timeframes suggested is feasible. Halamka concluded his post saying, “I will watch closely for comments from organizations such as the AMA, AHA, and clinician practices. (It should be noted that following the release of the rule, various healthcare associations had a mostly positive outlook). I’m guessing that many will see the ONC surveillance provisions as overly intrusive and the ‘advancing care information’ requirements as creating more burden without enhancing workflow. Maybe the upcoming Presidential transition (whoever is elected) will give us time to pause and reflect on what we’ve done to ourselves. As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.”



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