How far behind the curve are practicing physicians when it comes to MACRA (the Medicare Access and CHIP Reauthorization Act of 2015)? Honestly, pretty far behind. Certainly, that’s what the results of a recent survey report cosponsored by Healthcare Informatics have found. Healthcare Informatics came together with the leaders of SERMO, a global social network for physicians founded in 2005, to survey physicians’ understanding of and attitudes towards, MACRA, including components of the law, both the MIPS (Merit-based Incentive Payment System) program and its APM (alternative payment model) element.
The report, written by Healthcare Informatics Managing Editor Rajiv Leventhal, includes very important survey results, including that only 20 percent of practices with 15 physicians or fewer, report that they are “ready to go” to meet the core requirements under MACRA. Meanwhile, only 28 percent of practices with 16 to 50 physicians are “ready to go.” Clearly, that means that a large majority of physician practices are essentially unready to fulfill MACRA’s requirements, especially considering that 60 percent of survey respondents practice in groups of 15 physicians or fewer, and another 16 percent practice in groups of 16 to 50 physicians.
Consider also that only 9 percent of physician respondents to the survey practice in groups of 51-100 doctors, and 15 percent practice groups of more than 100 doctors. And all of those numbers reflect percentages from a survey that captured responses from nearly 2,100 physicians in practice.
Given that the vast majority of physicians in the U.S., at least numerically speaking, are still practicing in at least relatively small medical groups, there is a vast gulf between what those physicians will need and what they have at their disposal as informational, IT, analytics, and other resources right now. Certainly, physicians practicing in the largest medical groups are, by and large, well-positioned when it comes to MACRA; indeed, it’s the largest and most sophisticated medical groups that are already largely involved in one or more forms of risk-based contracting.
What of the other physicians, the ones not already involved in accountable care organizations, voluntary bundled payment contracts, and population health management initiatives? Well, under MACRA/MIPS, they’re going to need to begin to ramp up their sharing of data with the Centers for Medicare and Medicaid Services (CMS), around four key areas: quality, resource use (cost), “Advancing Care Information,” a set of requirements coming out of meaningful use that includes demonstrating the use of certified information technology; and clinical practice improvement activities. Granted, 2017 will be a relatively easy starter year for many physicians. But beginning in 2018, things will change, and things will ramp up pretty quickly. And virtually all of those physicians who are behind the curve will be in MIPS, because only a minority are ready now to leap into advanced payment model (APMs), which will also require a lot of data-gathering and data-sharing with Medicare.
And of course, that reality inherently favors larger medical groups. That point has, of course, been widely commented on, for example, in an analysis last summer by Ron Shinkman in NEJM Catalyst, published by The New England Journal of Medicine. “[A]s the rest of the physician community has had time to review the proposed regulations, concerns have begun to grow,” Shinkman wrote last August 4 in a piece entitled “Physician Frustration and Fear of MACRA.” “One of the biggest worries for many,” Shinkman noted, “is that MACRA’s quality initiatives will favor larger practices with vast resources but create a burden for smaller practices. For one thing, large practices will find it easier to participate in group reporting registries, which is required for many MACRA quality measures. Doctors working solo will at the very best be able to avoid some cuts, as opposed to reaping some financial benefits.”
Meanwhile, writing in Physicians Practice in October of last year, Barrow Koslow and Dennis P. Sexton of MKA Executive Planners, a Massachusetts-based executive benefit and retirement planning firm, wrote, under the headline “MACRA, MIPS and APMs: An Unappetizing Alphabet Soup,” “Some of us remember the punch line of those 1970s oil filter ads, with the mechanic holding the wrench and saying, ‘You can pay me now or you can pay me later.’ The clear message is that, either way, there would be an expense and that a small up-front payment may eliminate a larger one down the line.” Indeed, Koslow and Sexton noted, “Providers that have not prepared for this sea change in reimbursement will likely have to decide to make an investment now in an attempt to meet quality targets, or defer action and brace for the penalties coming in a couple of years. For these practitioners, it is not yet clear if one option is even less desirable than the other.” They also said this: “Some have stated that MACRA will be a death knell for solo practitioners. While reports of their death have been greatly exaggerated in the past, the embellishment is getting less far-fetched by the minute, as the proposed regulations seem to suggest that there clearly is strength in numbers.”