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Survey: Low Physician Awareness, Lack of Preparation for MACRA

July 14, 2016
by Heather Landi
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According to both independent and employed physicians surveyed, a third to two-thirds of remaining independent physicians will consolidate in the next three years due to MACRA and overall financial pressures in healthcare.
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While the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is on track to fundamentally change how physicians are reimbursed under the Medicare Physician Fee Schedule (PFS), half of surveyed physicians have never heard of MACRA, according to a new survey by Deloitte.

The Deloitte Center for Health Solutions polled 600 physicians for the survey, with the aim of gauging physician awareness of MACRA as well as physicians’ perspectives on the law's implications and their attitudes toward and readiness for change. MACRA applies financial incentives for healthcare professionals to participate in risk-bearing, coordinated care models and to move away from the traditional fee-for-service system. MACRA’s final rule from the U.S. Centers for Medicare & Medicaid Services (CMS) is expected this fall, and the first performance reporting period, as it stands now, will begin January 1, 2017.

Although, as reported by Healthcare Informatics’ Managing Editor Rajiv Leventhal, CMS Acting Administrator Andy Slavitt left open the possibility of delaying the start date for MACRA during a recent U.S. Senate Committee on Finance hearing.

The survey findings indicate that 50 percent of non-pediatric physicians have never heard of MACRA and 32 percent only recognize the name “MACRA.”

Additionally, 21 percent of self-employed physicians and those in independently owned medical practices report they are “somewhat familiar” with MACRA compared to 9 percent of employed physicians surveyed, according to the Deloitte press release announcing the survey. As self-employed and independent physicians are more directly responsible for their practices’ business requirements, that could be the reason for the difference in awareness levels.

The survey also found that physicians with a high share of Medicare payments are just as unaware of MACRA as others.

“The changes associated with MACRA are fast approaching,” Anne Phelps, principal, Deloitte & Touche LLP, and U.S. health care regulatory leader, said in a prepared statement. “The first performance reporting period begins January 1, 2017. The fact that so many physicians and clinicians still haven't heard of the law means they'll have a lot of work to do over the next five months, including evaluating current payment processes and understanding how physicians are organized within their hospitals or practices.”

Recently, as reported in Healthcare Informatics, the U.S. Department of Health and Human Services (HHS) announced $100 in funding for on-the-ground MACRA training and education for Medicare clinicians in individual or small group practices.

According to the Deloitte survey, many physicians surveyed recognized they will need new capabilities in order to bear increased financial risk, especially supporting capabilities as it relates to reporting. Not surprisingly, 42 percent of surveyed physicians would like standardized quality measures, 29 percent cited the need for analytics and other monitoring tools to track high-cost patients and 28 percent cited the need for standardized cost measures.

MACRA offers financial incentives for physicians and clinicians to move growing percentages of their practices to risk-bearing, coordinated-care models but, according to the survey, most physicians would have to adjust their current approach and practice management to meet the law's requirements and do well under its incentives.

Currently, physicians have low preference for most value-based payment models, according to the survey, with nearly 8 in 10 physicians surveyed preferring fee-for-service or salary for their compensation.

Additionally, 71 percent of physicians would participate in value-based payment models if offered financial incentives to do so, and 52 percent would opt for shared savings, which is not a qualifying Advanced Alternative Payment Model (APM) under MACRA.

Presently, performance bonuses are less than or equal to 10 percent of current compensation for half of physicians surveyed, and 33 percent reported that they are not eligible for performance bonuses.

One of the biggest changes for physicians under MACRA will be the need to bear increased financial risk, although the surveyed physicians indicated they feel increased financial pressures in general. For this reason, most surveyed physicians (80 percent) expect MACRA to drive increased physician consolidation, either by joining larger organizations or networks. And, half of those surveyed say financial pressures are the number one driver of consolidation.

Specifically, 58 percent of physicians would opt to be part of a larger organization to diminish individual physician risk and bear risk collectively and/or to have access to a full spectrum of resources and capabilities. One in four of independent physicians would prefer to be employed while 75 percent would prefer to join a clinical network.

In the next three years, one third to two-thirds of the remaining independent physicians will consolidate, according to predictions by both independent and employed physicians who participated in the survey.

The survey found the majority of physicians, around 70 percent, believe that the performance of the U.S. health care system can be improved by measuring care outcomes and processes and measuring resource utilization and costs, but, conversely, the survey also found most physicians believe performance reporting to be burdensome (74 percent), while 79 percent don't support tying compensation to quality.

In fact, half of physicians surveyed do not support individual public quality reporting as would be required by the Merit-Based Incentive Payment System (MIPS) track of MACRA.

Regarding attitudes and perceptions about MACRA, it’s perhaps no surprise that surveyed physicians open to participating in value-based payment models have more positive expectations for the law, as well as healthcare transformation in general.

According to the survey report, researchers gave physicians a brief explanation of MACRA and then polled them on their expectations. The findings indicate sharp difference between physicians who are willing to participate in value-based payment models and those who are unresponsive to incentives.

Of those surveyed physicians willing to participate in value-based payment models with financial incentives:

23 percent indicated that the law would reduce costs

19 percent indicated it would improve quality

47 percent believe that value-based payment models can improve the performance of the U.S. healthcare system

Of those surveyed physicians who are unresponsive to incentives:

9 percent felt that the law would reduce costs

5 percent said it would improve quality

23 percent believe in value-based payment models


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