The proposed rule is less than a week old but Linda Girgis, a family medicine physician in South River, N.J., is not too pleased with the Medicare Access and Summary CHIP Reauthorization Act of 2015 (MACRA).
If CMS' own projections are accurate, in two-and-a-half years, she'll be joined in her dissent by many other small practice docs across the country. By next year, MACRA will change the way physicians are reimbursed for Medicare, combining and configuring the Physician Quality Reporting System (PQRS), the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program (Meaningful Use).
For more on MACRA, read this breakdown of how the proposed rule would work and impact practices.
Yet, the cost could come at the expense of solo and small practice physician practices. CMS projected that in 2019, 87 percent of solo practices will be hit with a negative Medicare payment adjustment as will almost 70 percent of practices with two to nine eligible docs. The overall financial impact on solo doc practices will be $300 million and for two- to nine-doc practices, it will be $279 million.
For that reason, Girgis is already speaking out against the proposed rule and hoping other small practices will join her advocacy efforts. She spoke with Physicians Practice on the rule, what it will mean for small practices, and why it's not easy to opt out of Medicare. Below are excerpts from their conversation.
Physicians Practice: You have not been shy in your criticisms of MACRA, what are your biggest problems with the proposal?
Linda Girgis: It's penalizing small practices and solo doctors. It was supposed to be based on quality initiatives, and [CMS] has already revealed how many bonuses they're going to give, how many negative adjustments. I thought this was supposed to be about quality, but it's obviously about balancing their budget rather than improving quality healthcare.
PP: Is any of it salvageable in your eyes?
Girgis: I think [CMS] is going about it the wrong way. I think patients need quality medication, but they are serving their political agendas, rather than have it be about clinical outcomes. They said they are making it patient-centric, but that's not true. They have it so people are focused on the data, rather than the patients.
The metrics [look at patients as data points]… there are patients who are sick with multiple diseases [that won't be looked at positively in terms of data analysis] but you can improve their health. Under this incentive system, you get penalized for spending a lot of time with those patients who are never going to get better.