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Another MACRA Survey Reveals Alarmingly Low Levels of Knowledge

October 31, 2016
by Rajiv Leventhal
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Nearly nine in 10 respondents to a Medscape survey said that they either have not heard of, don’t know a lot about, or know a little bit about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its core components.

The survey, delivered online throughout September, included responses from the 282 physicians who saw 20 or more patients per month, meaning before the MACRA final rule was published by the Department of Health & Human Services (HHS) on Oct. 14. Indeed, 87.8 percent of respondents revealed they are very unfamiliar with the new law that will fundamentally change how eligible Medicare physicians will be reimbursed, starting with an outcomes-based Quality Payment Program set to kick off in 2017. Only 2.1 percent of respondents said they knew a lot about MACRA.

Most of this survey’s respondents are practicing either in small groups (21.4 percent) or large groups (21.8 percent); 12.6 percent are solo practitioners; and most of the respondents are practicing either in academic hospitals (22.1 percent) or community hospitals (20.2 percent).

According to federal officials, MACRA aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (Advanced APMs). Nonetheless, the Medscape research found that 91.5 percent of respondents either have not heard of, don’t know a lot about, or know a little bit about MIPS, while only 2 percent said they know a lot about the payment track that most providers will initially participate in.

While the government has afforded clinicians flexibilities that will allow them to pick their pace of participation for the first performance period starting in Jan. 2017, it does appear troubling that so few doctors know much about MACRA at this juncture. Similarly, a Deloitte Center for Health Solutions survey of 600 physicians from this summer revealed that 50 percent of non-pediatric physicians have never heard of MACRA and 32 percent only recognize the name “MACRA.”

The Medscape survey also asked Medicare doctors what their current payment arrangements were. Roughly 61 percent responded “fee-for-service, commercial;” some 49 percent said “fee-for-service, Medicare;” and 9.6 percent reported “bundled payment or episode of care.” Meanwhile, 28 percent of respondents disagree either completely or somewhat that they have sufficient infrastructure to support payer requirements.

About half (51 percent) of respondents said they are already report PQRS (Physician Quality Reporting System) to the Centers for Medicare & Medicaid Services (CMS), and of those who of those who do report, most of them (63.5 percent) report via an electronic health record (EHR), qualified registry. Of those who don’t report (96 respondents), most don’t report because they don’t know how (34 percent). Other reasons for not reporting included “cash-based practice,” “none of the government’s business,” and “I don’t know what that is.” PQRS is now re-labeled the “Quality” category under MIPS, and is one of the existing quality reporting programs that MACRA streamlines into the Quality Payment Program.

What’s more, free form responses of the survey suggest that the most common concerns about MACRA are: lack of knowledge about how to participate; will detract from the “humanity” of medicine; will require more paperwork time at the expense of patient time; and will penalize physicians for things that are out of their control.

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