According to Robert Kocher, MD, and Anuraag Chigurapati, MS, at policy institutes at the University of California, Stanford, and Harvard, the MACRA endgame is designed to redistribute income to primary care physicians from specialists ("The Coming Battle over Shared Savings - Primary Care versus Specialists," New England Journal of Medicine, July 14, 2016,) In a sample chart in their article, the authors project MACRA could reduce incomes for diagnostic radiologists by $35,000 and cardiologists by $25,000, thereby narrowing the average incomes of $284,000 of specialists versus $195,000 for primary care physicians.
Will this MACRA scenario work in the real world?
I am profoundly skeptical about MACRA. It’s hard to understand, rests on non-commonsensical assumptions, and its bloated bureaucratic rules will raise costs. Pitting primary care doctors against specialists will be psychological offensive t many doctors, and it won’t raise quality since many consumers regard specialty essential in many instances.