Industry surveys conducted earlier this year indicated that many healthcare professionals were not familiar with the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP), and a recent survey paints a similar, stark picture—half of healthcare professionals are still not familiar with MACRA.
However, the survey findings also indicated that healthcare professionals who felt that they are knowledgeable about MACRA are much more likely to believe that MACRA will have a positive effect on their practice, and are less likely to cite that they are “unsure” of how it will impact them.
MACRA is the law that starting in 2019 will replace the Sustainable Growth Rate Model with a value-based system with the goal of creating a different more sustainable payment system for providers and physicians. There are two tracks in MACRA— Advanced Alternative Payment Models (APMs) or the Merit-based incentive Payment System (MIPS).
NueMD’s 2017 MACRA Survey found a great deal of uncertainty about MACRA and its impact on physician practices, as 50 percent of responding healthcare professionals said they are “not at all” familiar with MACRA, 41 percent said they are “somewhat familiar” and only 9 percent said they are “very familiar” with MACRA.
The most common answer to every question in the NueMD survey was “I’m not sure.”
NueMD surveyed 1,052 healthcare professionals about their feelings toward MACRA. The survey was conducted from April to June 2017.
The majority of respondents (63 percent) work at small practices (one to three providers) and about half of respondents (42 percent) own their practice/business. More than 50 medical specialties are represented in the survey, according to NueMD, with the top five specialties as the following: mental health, family practice, internal medicine, physical therapy and general practice. And, about half of respondents were patient care professionals, followed by office manager and then administrator.
More than half (56 percent) of respondents said they did not know whether they qualify to participate in MACRA’s Quality Payment Program, however the survey authors note that during the survey period, the Centers for Medicare & Medicaid Services (CMS) issued notices to physicians by mail if they are expected to participate in 2017.
The survey also found that MACRA information is not easy to find, as survey participants were asked if they had ever encountered information on MACRA, including articles, webinars, and infographics. Most said no. In fact, 49 percent said they have not encountered any information on MACRA.
According to the survey findings, the biggest influence on how physicians feel about MACRA is their familiarity with it. When asked how they expect MACRA to impact their practice over the next three years, 63 percent of respondents said, “I’m not sure." Fifteen percent responded that it would have a negative impact. Only 9 percent expect it will have a positive impact.
When NueMD took a closer look at responses from healthcare professionals who said they felt knowledgeable about MACRA or “very familiar” with it, there seemed to be pattern, with the majority of those respondents citing that MACRA would have a positive effect on their practice over the next three years (35 percent). What's more, the percentage of those who said they were unsure (30 percent) was cut in half, as compared to 63 percent of total respondents who said they were unsure.
Medicare Part B clinicians want to know how MACRA is going to affect their financial health, and the survey asked respondents to consider MACRA’s effect on their financial wellbeing over the next three years. Sixty-one percent said they have no idea how MACRA will affect their practice financially, with the rest divided fairly evenly among a positive (10 percent), negative (10 percent) or neutral (19 percent) outcome.
And, the survey found that MACRA “savvy” professionals tend to see a positive financial impact from MACRA. More than one-third (39 percent) of those comfortable with MACRA believe it will have a positive impact on their practice’s financial wellbeing, which represents a larger percentage than the “I’m not sures,” which dropped to 31 percent. Twenty-three percent believe it will have a negative impact on their financial wellbeing and 7 percent believe it will have a neutral impact.
Practice size seemed to be a factor in whether respondents believe MACRA will have a positive or negative impact. The majority of both groups feel uncertain, as 58 percent of small practices and 66 percent of large practices said “not sure” about the financial impact. However, small practices largely foresee a negative financial future (25 percent), while large practices predict a positive one (16 percent), according to the survey.
Looking at the administrative impact, the majority of healthcare professionals (58 percent) said they aren’t sure how MACRA will impact their workflow, but 27 percent predicted they will spend more time reporting and only 3 percent of respondents said they will spend less time on reporting.
Those who know about MACRA agree about reporting requirements. While the majority (48 percent) expect to spend more time reporting, 25 percent expect their administrative burden to stay the same.
Impact on Quality, Cost of Care
Respondents also were surveyed about what impact they believe MACRA will have on the quality of patient care. As with all the other questions, the majority (62 percent) said they weren’t sure, and the rest were evenly split between expecting patient care to worsen (16 percent), improve (10 percent) or for MACRA to have no effect on patient care (10 percent). And, those familiar with MACRA also were decisively split, with 21 percent saying they are unsure of the impact on patient care, 28 percent expecting patient care to worsen, 31 percent expecting it to improve and 20 percent expecting there to be no effect on patient care. Large practices are slightly more optimistic, with 16 percent expecting patient care to improve, compared to 7 percent of small practices.
What’s more, respondents also were gauged about how they think MACRA will impact the cost of healthcare for patients. Sixty-five percent feel uncertain about the impact on cost of patient care, however, many (20 percent) think it will be negative.
Small practices, however, think it’s more likely to have a negative impact (25 percent), while large practices are split equally between positive and negative outcomes (13 percent and 13 percent).
“Respondents indicated they expect both patients and practices will shoulder the financial burden of MACRA. We expected to see everyone pick one or the other. Proof that professionals are experiencing both uncertainty and pessimism about MACRA,” the survey authors wrote.
Among respondents familiar with MACRA, 32 percent think it will have a negative impact on the price of care, but that’s only slightly more than those who weren’t sure (28 percent).
The survey authors concluded, “Though the numbers seem bleak, there is one positive take away: Professionals, who understand MACRA, are increasingly optimistic. We discovered that despite knowing they’ll spend more time reporting, respondents who are very familiar with MACRA believe it will ultimately have a positive impact on their practice over the next three years.”