The Medicare Access And CHIP Reauthorization Act And The Corporate Transformation Of American Medicine

Abstract

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may accelerate the movement of physicians into corporate employment by hospitals and, to a lesser extent, by health insurers and other corporations. This article briefly summarizes the demographics of US physician practice, the potential advantages and disadvantages of physician employment by large corporations, and the evidence to date on the performance of large versus small physician practices and hospital-employed versus independent physicians. It describes the features of MACRA likely to lead physicians to seek corporate employment and the steps the Centers for Medicare and Medicaid Services has taken through MACRA to aid small independent physician practices. I conclude that MACRA's net effect is likely to be accelerated corporate employment of physicians and that there is an urgent need for more evidence on the impact of different types of provider organization on the quality and cost of care, and on patient, physician, and staff experience.

Keywords: Hospitals; MACRA; Medicare; Organization and Delivery of Care; Physician Payment.