After the "Doc Fix": Implications of Medicare Physician Payment Reform for Academic Medicine

Publisher: Academic Medicine, vol. 91, no. 7
Jul 01, 2016
Eugene C. Rich and James D. Reschovsky
The Medicare Access and CHIP Reauthorization Act (MACRA) introduces incentives for  clinicians serving Medicare patients to move away from traditional “fee-for-service” and into alternative payment models(APMs) such as accountable care organizations and bundled payment arrangements. Thus, MACRA creates strong reasons for various teaching clinical services to participate in APMs, not only for Medicare patients but for other public and private payers as well. Unfortunately, different APMs may be more or less applicable to the diverse teaching physician roles, academic clinical programs, and patient populations served by medical schools and teaching hospitals. Therefore, this time of transition will complicate the work of academic clinical program leaders endeavoring to sustain the tripartite mission of patient care, health professional education, and research. Nonetheless, payment reforms promoted by MACRA can reward efforts to reinvent medical education to better incorporate value into medical decision making, as well as to give clinical learners the tools and insights needed to recognize their personal financial(and other) conflicts and navigate these to meet their patients’ needs.