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Family Medicine Physician Shares Doubts on MACRA : Page 2 of 2

Family Medicine Physician Shares Doubts on MACRA : Page 2 of 2

PP: Why are physicians especially concerned about the proposed quality benchmarks?

KM: Some of the concerns expressed at the [AAFP Annual Chapter Leader Forum] that I was at is that oftentimes with the changing [standards] and research in medicine, the benchmarks don't always make sense. For example, Meaningful Use had benchmarks related to hemoglobin A1C, which is a measure for diabetes control. It was across the board, "How many of your diabetes patients have an A1C less than seven?" Because less than seven is the goal. But the reality is, the research and guidelines support this, as you get older patients and patients with a lot of comorbidities, that seven is actually not a good number. You are really looking at more like an eight. And maybe even an eight and a half — because if you get them close to a seven or less, you run the risk of having a significant hypoglycemic event that could kill them. So the doctors say, "Well I can either do what is best for my patient, which is not control them to a seven (and lose out on that potential benchmark) [or follow potentially bad clinical guidelines] ... but I think doctors are really concerned about any benchmark that is outside the control of the doctor. 

PP: What were you hearing about MACRA from other physicians at the AAFP meeting?

KM: They did end up having a session where someone from CMS was on the phone and they had a town hall Q&A session. The lines of people asking questions were quite enormous. People were asking questions related to the cost of doing this…"How are we supposed to deal with metrics that we don't even know what they are yet?" And a lot of people are concerned that people who have never been in an exam room are making decisions about what we should and shouldn't do in an office. How is that is OK? There are people (according to comments on the AAFP website) who are really trying to force the AAFP [to eliminate MACRA], they don't think we should have anything. But I don't think that is a reality. These value-based payments and new models have been coming down the road for a long time. This has been where things are going. I think people are very frightened about having metrics they have no control over, that may not be evidence-based at all, and the politics that are involved in developing them. And what that ultimately is going to mean for people in practice. [Physicians] are certainly talking about just not taking Medicare anymore. Certainly when Meaningful Use came in we did see a drop in people taking new Medicare patients.

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