In Blog Post, Dr. John Halamka Rips Apart Proposed MACRA Rule | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

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

May 6, 2016
by Rajiv Leventhal
| Reprints

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.”

Get the latest information on Meaningful Use and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More



NewYork-Presbyterian, Walgreens Partner on Telemedicine Initiative

NewYork-Presbyterian and Walgreens are collaborating to bring expanded access to NewYork-Presbyterian’s healthcare through new telemedicine services, the two organizations announced this week.

ONC Releases Patient Demographic Data Quality Framework

The Office of the National Coordinator for Health IT (ONC) developed a framework to help health systems, large practices, health information exchanges and payers to improve their patient demographic data quality.

AMIA, Pew Urge Congress to Ensure ONC has Funding to Implement Cures Provisions

The Pew Charitable Trusts and the American Medical Informatics Association (AMIA) have sent a letter to congressional appropriators urging them to ensure that ONC has adequate funding to implement certain 21st Century Cures Act provisions.

Former Michigan Governor to Serve as Chair of DRIVE Health

Former Michigan Governor John Engler will serve as chair of the DRIVE Health Initiative, a campaign aimed at accelerating the U.S. health system's transition to value-based care.

NJ Medical Group Launches Statewide HIE, OneHealth New Jersey

The Medical Society of New Jersey (MSNJ) recently launched OneHealth New Jersey, a statewide health information exchange (HIE) that is now live.

Survey: 70% of Providers Using Off-Premises Computing for Some Applications

A survey conducted by KLAS Research found that 70 percent of healthcare organizations have moved at least some applications or IT infrastructure off-premises.