ISMA joins AMA in seeking higher physician pay, other MACRA fixes
Regular pay increases for physicians who treat Medicare patients tops a list of legislative improvements being sought by the AMA, ISMA and other state and national physician groups.

The recommendation comes in a letter from the AMA and other signatories to congressional leaders, urging them to refine and improve the Medicare Access and CHIP Reauthorization Act (MACRA). The letter and its attached proposed legislative improvements grew out of a workgroup convened by the AMA to help smooth the Centers for Medicare and Medicaid Services’ (CMS) transition from sustainable growth-rate payments to MACRA’s outcome-based Merit-Based Incentive Pay System (MIPS) and Alternative Payment Models (APMs).

The workgroup’s first proposed improvement is to make sure that Medicare payments to participating physicians reflect inflation and the steadily increasing costs of medical practice. The Medicare Physician Fee Schedule now includes a six-year gap from 2020 to 2025, during which no payment updates are planned. The workgroup proposes replacing that freeze with positive payment adjustments for physicians, noting that Medicare physician pay increased just 6% from 2001 to 2017, while hospital and skilled nursing facility pay increased 50% and 51%, respectively, and the cost of running a medical practice increased 30%.

“Adjusted for inflation in practice costs, Medicare physician pay has declined 19% from 2001 to 2017, or by 1.3% per year on average,” the proposal says. “CMS actuaries believe ‘absent a change in the delivery system or level of update by subsequent legislation, we expect access to Medicare participating physicians to become a significant issue in the long term under current law.’”

Other proposed improvements to MIPS include providing scoring flexibility to CMS to allow for multicategory credit, providing flexibility to CMS to set multiple performance thresholds, updating the promoting interoperability performance category, improving the cost performance category, aligning comparisons in the MIPS Quality performance category and Physician Compare, incentivizing new measures and ensuring stability for existing measures.

Proposed improvements to APMs include extending APM incentive payments, adding qualified APM participant (QP) threshold flexibility, adjusting multipayer QP thresholds, mitigating APM overlap issues, excluding the revenues from Part B drugs, and expanding medical homes.

To read details of the proposed legislative improvements to MACRA, visit

See the letter to congressional leaders at