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Addressing Physician Concerns about MACRA and APMs

Addressing Physician Concerns about MACRA and APMs

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is one of the biggest shifts in physician payment in decades. Yet for such an industry change, the impact on most physicians will be modest and incremental. Take stock now of the challenges facing physicians and then scale an effective and lasting approach for your group or organization.

What is MACRA?

MACRA, a related but distinct legislative byproduct of the Affordable Care Act (ACA), seeks to incentivize improved outcomes and overall quality of care. Centers for Medicare & Medicaid Services (CMS) created guidelines that tie provider reimbursement to cost-effective, high-quality care. MACRA replaces the unpopular Sustainable Growth Rate (SGR) and provides incentives to physicians for the quality of care they provide. Physicians who outperform their peers on measures of quality, health record interoperability, care improvement, and cost may see higher payments, while under-performing or non-reporting physicians will be penalized. These changes will be incremental and take several years before fully implemented. Physicians and groups participating in Medicare Advanced Alternative Payment Models (APMs) are exempt from MACRA incentives.

Most physicians are not yet familiar with MACRA, according to the Deloitte Center for Health Solutions 2016 Survey of U.S. Physicians. The survey revealed that 50 percent of physicians have never heard of the law, and 32 percent recognize it by name but are not familiar with its requirements. The study found employed physicians were less likely to be familiar with MACRA than independent physicians.

The impact of MACRA on individual physicians and groups

MACRA’s impact on individual physicians and groups is variable, as the law mostly affects physician practices who care for seniors and who bill Medicare under traditional fee for service. The law has limited or no impact on providers who care primarily for children and younger adults, and who provide services predominantly to patients insured under Medicaid and commercial health plans. Managed Medicare Plans are not affected by MACRA, although this could change in the future. 

Practices most likely to benefit from the new law are those that previously invested in EHR, quality measurement and reporting, care process improvement, and providing low cost care. MACRA also rewards practices already participating in demonstration projects with quality and cost incentive programs, such as advanced medical homes and Accountable Care Organizations (ACOs). 

Physician impact is not limited to reimbursement. MACRA builds upon and refines existing quality incentive programs (Meaningful Use and the Physician Quality Reporting System PQRS). Some specialists will want to take advantage of new and more pertinent quality metrics. New options exist for group rather than individual reporting, reducing administrative burden for many practices. Physicians who see fewer than 100 Medicare patients annually or less than $30,000 in annual charges are excluded. Most importantly, performance on quality scores will now determine whether physicians are financially rewarded or penalized. Physicians need to expect their quality scores will be reported publicly and integrated into star ratings. When communicating with physicians, be prepared to describe specifically how each physician and group will be measured and what choices face the practice about selecting quality metrics.

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