Will physicians be burned by MACRA surprises?

A comprehensive 2016 study by The Physicians Foundation examined physician attitudes toward their work life and uncovered various attitudes and beliefs that are certain to affect how they respond to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). More than 17,000 physicians responded to the survey and submitted an astonishing 10,000 comments about their work life, many of which focused on ever-growing administrative work related to insurance and government reimbursement.

Alarming lack of MACRA awareness

Even with healthcare predominant in headlines, an alarming number of physicians continue to be unfamiliar with MACRA. Depending on variables such as gender, age, type of practice and other demographics, the share of physicians who were “somewhat unfamiliar” or “very unfamiliar” with MACRA ranged from 53 to 61 percent. This is bad news for any of them who are treating Medicare patients or plan to. The data collected in 2017 will affect how physicians are reimbursed starting in 2019.

The lack of MACRA awareness may stem from the relatively low share of physicians who are tied to value and quality-based metrics. The survey uncovered how doctors are reimbursed:

  • 42.8 percent say they are paid on value/quality measures
  • 45.1 percent rely on traditional fee-for-service
  • 12.1 percent are unsure of how they are compensated

The “unsure” may reflect the fact that physicians who are employed by systems may be unaware of reimbursement structures and patterns.

MACRA may become model for insurers

Much of the future of MACRA rests on the new leadership at the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). Timing will be important.

“A (Tom) Price-led HHS won’t have a great deal of time before it needs to alert providers as to what the 2018 version of the MACRA law will look like,” David Pittman of POLITICO writes. “CMS bent over backward to make it easy for doctors in 2017 by offering them a ‘pick-your-pace’ format.”

Physicians should heed MACRA because its success could lead to insurers adopting the model, according to The Physicians Foundation report.

For those who are ready to dig in, the MACRA Final Rule is 2,200 pages long (a four-page summary for primary care is available from the American Academy for Family Physicians). There are also excellent MACRA resources at the CMS website and the American Medical Association.

All providers will continue to need help navigating clinical and administrative complexities as the industry evolves. Reducing time spent on administrative tasks can help ease the burden of change. ABILITY can be a steady partner in helping providers stay focused on patient care. Check out our resources here.