John O’Shea, MD, is currently a practicing surgeon and Senior Fellow in the Center for Health Policy Studies at the Heritage Foundation in Washington, DC. Prior to taking his current position, he was a Visiting Scholar in Health Policy at the Brookings Institution. From 2011 to 2013, he served as a senior health policy advisor to the U.S. House Committee on Energy and Commerce, where he helped draft the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that replaced the Sustainable Growth Rate (SGR) formula for reimbursing physician services in the Medicare program.
Recent Posts by John O'Shea
Unless there are substantive changes to how the law is implemented, MACRA is unlikely to realize the goal of establishing a Medicare payment system that rewards the value and not the volume of health care services.
MACRA threatens to push many providers out of fee-for-service before they have a safe place to land. Policy makers should consider both making the Merit-Based Incentive Payment System less onerous and greatly accelerating the development and implementation of viable alternative payment models.
The MSSP and Pioneer ACOs have generated a considerable number of valuable ideas and initiatives toward meaningful health care payment reform. However, a more detailed analysis shows that maybe the results are not as good as the recent report would have you believe.
Recent policy changes and announcements follow widespread calls to move from the current volume-based fee-for-service payment system to a value-based system that pays for patient outcomes rather than individual services. But there are major challenges to achieving that goal.