Shortly after the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in April 2015, Centers for Medicare & Medicaid Services’ (CMS) Chief Actuary Paul Spitalnic predicted that, starting in 2026, Medicare Part B payments under MACRA will reduce access to physicians and the quality of services they provide.

“While physician payment updates would be adequate for many years, there are a number of concerns about the specified updates in the long range,” Spitalnic said in a statement. “In particular, the physician payment rates would be problematic under H.R. 2 in years with high inflation, in 2025 when the 5-percent APM bonus and the $500 million additional pool for MIPS are scheduled to expire, or at the point when the cumulative effects of payment updates not keeping up with physician costs become too large. If not addressed by subsequent legislation, we expect that access to, and quality of, physicians’ services would deteriorate over time for beneficiaries.”

This prediction is the result of a little-known effect of the lower update factors in MACRA.  Many physician trade associations and professional societies hailed MACRA as a victory when it passed in 2015 because it repealed the sustainable growth rate (SGR) that threatened a one-time 21 percent cut in physician payments under Part B. However, according to CMS’ actuary, MACRA effectively freezes the level of Part B payments over the next 75 years at approximately 2.5 percent of GDP.

So, as you gobble down a frozen concoction during this week’s oppressive summer heat, remember that swallowing something too quickly (like MACRA’s promised heroics) can sometimes lead to a “brain-freeze” you will regret.