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Understanding the impact of ‘cost’ under MACRA: a neurointerventional imperative!
  1. Gabriela Spilberg1,
  2. Gregory N Nicola2,
  3. Andrew B Rosenkrantz3,
  4. Ezequiel Silva III4,
  5. Clemens M Schirmer5,
  6. Brian B Ghoshhajra1,
  7. Nirmal Choradia6,
  8. Rose Do7,
  9. Joshua A Hirsch8
  1. 1 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Hackensack Radiology Group, Hackensack, New Jersey, USA
  3. 3 Department of Radiology, NYU Langone Medical Center, New York, USA
  4. 4 South Texas Radiology Group, San Antonio, Texas, USA
  5. 5 Department of Neurosurgery, Neuroscience Institute, Geisinger, Wilkes-Barre, Pennsylvania, USA
  6. 6 Acumen, LLC, Burlingame, California, USA
  7. 7 Department of Cardiology and Cardiac Surgery, Veterans Affairs Medical Center, Long Beach, Kaiser Permanente of Southern California, Acumen, LLC, Long Beach, California, USA
  8. 8 Interventional Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Joshua A Hirsch, Interventional Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; hirsch{at}


The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called ‘cost’. Understanding cost as a dimension that contributes to the value of care delivered is critical for succeeding in MIPS and offers a meaningful route for favorably bending the cost curve.

  • socioeconomics
  • health care policy
  • QPP
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  • Contributors The initial draft was prepared by GS and JH. All authors reviewed the draft, provided meaningful edits, contributed to, and approved, the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests JAH has consulted for Medtronic and Globus in the last 36 months – unrelated. JAH and ABR are supported by Research Grants from the Harvey L. Neiman Health Policy Institute NC and RD and both work for Acumen, LLC. This article does not express the opinions of Acumen, LLC.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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