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Many physicians still worried about MACRA

 

Despite soothing words from CMS, and some adjustments based on criticisms from providers, many physicians remain worried that the  final rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA) is still too narrow and complex to reach its  goal of creating a mostly value-based payment system.

Many fear that the final rule will hurt small and rural medical practices and set primary-care doctors against specialists.

Under MACRA, better-performing doctors will get bonuses and under-performers will face financial punishments based on a variety of metrics of cost and quality of care.

To read a MedPage Today article on this, please hit this link.

 


Survey: MACRA a mystery to 50% of physicians

 

Only about half of the physicians surveyed by Deloitte’s Center for Health Solutions are familiar with the provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) although it will bring about huge change in how healthcare is paid for and run.

MACRA is meant to speed healthcare’s transition to value-based payment models by offering  clinicians financial incentives to manage increasing percentages of patients under risk-sharing or coordinated-care contracts.

Becker’s Hospital Review summarized four survey findings:

1. “Nearly 50 percent of non-pediatric physicians surveyed said they had heard of MACRA.

2. “Self-employed physicians or physicians affiliated with independently owned medical practices (21 percent) were more likely to be at least somewhat familiar with MACRA than physicians employed by hospitals, health systems or medical groups (9 percent).

3. “Eight in 10 physicians said they preferred traditional fee-for-service or salary-based compensation models as opposed to alternative payment options. Many physicians said they believe performance reporting will be an administrative burden, according to Deloitte.

4. “Physicians largely agreed that the need to bear increased financial risk under quality-based care models will spur market consolidation. About 58 percent said they would consider affiliating with a larger organization to stay financially viable under value-based care models. Eighty percent of physicians said they expect their peers to join larger organizations or networks due to MACRA.”

For more information, please hit this link


MACRA seen causing physician exodus from Medicare

exodus

“Crossing of the Red Sea,” by Nicholas Poussin.

A Medscape survey shows that “almost 4 in 10 physicians in solo and small group practices predict a mass exodus from Medicare within their ranks on account of the program’s new payment plan and its punishing penalties.”

“Fifty-nine percent of physicians in practices with fewer than 25 clinicians also said they expect to receive a performance penalty as high as 4% under proposed regulations that implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Only 9% of physicians in under-25 groups expect a bonus, with another 12% counting on no change in compensation.”

“Roughly one third of physicians in small practices said merger into larger groups promises to be the most likely fallout from MACRA.”

It remains to be seen, of course, how much hyperbole there is in all this stemming from physician frustration at red tape and fear of falling incomes.

For the full Medscape article on this, please hit this link.


Deconstructing Medicare quality programs

 

alphabet

Have some alphabet soup.

This analysis breaks down the MACRA proposed rule. MACRA stands for this mouthful: the Medicare Access and CHIP Reauthorization Act. MIPS (below) stands for the Merit Based Incentive Payment System. Government programs, dating back to the New Deal, in the ’30s,  are rife with abbreviations.

As this piece in HealthAffairs reports:

“As outlined in MACRA, the proposal would consolidate three currently disparate Medicare quality programs into MIPS:  (1) the Physician Quality Reporting System; (2) the Value-Based Modifier Program; and, (3) the ‘Meaningful Use’ of electronic health records. CMS proposes that eligible clinicians receive a composite score relative to their performance in each of four categories. Quality measures for these core domains will be selected annually, with the data regarding clinician performance on the measures made available via the Physician Compare Web site.

“The four performance categories are:

  1. “Quality: 50 percent of total score in year 1;
  2. “Advancing Care Information: 25 percent of total score in year 1, formerly EHR Meaningful Use;
  3. “Clinical Practice Improvement Activities: 15 percent of total score in year 1, this is essentially the ‘new’ domain added to the previously existing other three.
  4. “Cost or Resource Use: 10 percent of total score in year 1, based on Medicare claims data — no reporting necessary.”

Meaningful Use program to end soon

 

CMS acting administrator Andy Slavitt said at a healthcare investors conference in San Francisco that the agency plans to end the Meaningful Use program soon.

“The meaningful use program as it has existed will now effectively be over and be replaced with something better,” he said Monday at the J.P. Morgan Healthcare Conference, adding that the new program’s details will be  disclosed in the next few months.

“Now that we effectively have technology in virtually every place care is provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation.” Mr. Slavitt was referring to  the Medicare Access and CHIP Reauthorization Act, which  repealed the Sustainable Growth Rate reimbursement formula. Most of MACRA’s provisions take effect in 2019.
“Providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government.”


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