Despite soothing words from CMS, and some adjustments based on criticisms from providers, many physicians remain worried that the  final rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA) is still too narrow and complex to reach its  goal of creating a mostly value-based payment system.

Many fear that the final rule will hurt small and rural medical practices and set primary-care doctors against specialists.

Under MACRA, better-performing doctors will get bonuses and under-performers will face financial punishments based on a variety of metrics of cost and quality of care.

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