MACRA likely to accelerate consolidation; will the regulatory framework support it?

Area of Science:

• Health Policy
• Medical Economics

Background:

• The sustainable growth-rate (SGR) formula was a flawed Medicare physician payment mechanism.
• Legislative efforts to reform SGR spanned nearly two decades.

Purpose of the Study:

• To document the legislative history and eventual repeal of the SGR formula.
• To highlight the transition to the Medicare Access and CHIP Reauthorization Act (MACRA).

Main Methods:

• Legislative analysis of congressional acts related to Medicare physician payment.
• Chronological review of policy changes from 1997 to 2015.

Main Results:

• The SGR formula, established in 1997, underwent numerous legislative modifications.
• The Medicare Access and CHIP Reauthorization Act (MACRA) finally repealed the SGR in April 2015.

Conclusions:

• The repeal of the SGR formula marked a significant shift in Medicare payment policy.
• MACRA introduced a new framework for physician reimbursement, emphasizing value-based care.