How doctors get paid is changing — but how do they feel about it?
Wednesday, August 30, 2017
For those in healthcare, the Medicare Access and CHIP Reauthorization ACT of 2015 (MACRA) is upon us, and the ideological payment shift in healthcare that has garnered "tremendous bipartisan support in both the House and Senate" is changing how caregivers get paid. The change (as you likely know) repealed the failing Sustainable Growth Rate (SGR) and shifts Medicare reimbursements to a new value-based model.
Because of the amount of media coverage in the past (and even now), the changes are clearly well-publicized and known, but there are some misconceptions and major concerns about what's to come. NueMD, a healthcare software as a service company headquartered in Marietta, Georgia, that develops electronic health records and practice management solutions, set about to measure and better determine the expected impacts of the change in payment regulation.
In a nutshell, the refreshed Medicare reimbursements are based on the quality of care a patient receives, not the number of encounters — clear enough and much debated for several years leading up to this change.
The reality of that is upon us, and MACRA remains an entirely new way of measuring and thinking about healthcare. On its own, MACRA is designed to stop the growing cost of healthcare, address budget deficits and increase the quality of healthcare.
Of course, we shall see. These are all good intentions, but it's still a sea change for the industry, and it falls on many like a brick and not a feather. As NueMD notes, despite MACRA's "ambitious vision, some argue that MACRA actually punishes physicians, especially those in small practices. Many U.S. physicians feel caught in the middle, forced to take on a large-scale transition by implementing MACRA on their own."
In its sector study, NueMD surveyed those in practice about their feelings toward MACRA from April 2017 to June 2017; 1,052 healthcare professionals responded, most of whom work in small practices, of one to three providers (63 percent); followed by 16 percent of respondents working in practices with between four and 10 providers.
MACRA will likely impact small practices the most, but a key takeaway from the report is that 42 percent of the respondents are the practice's business owner. Since the majority of survey-takers work in small practices, it seems obvious that almost half also are business owners and "when it comes to MACRA, the opinions of small practices owners matter the most," the report's writers point out.
Those specialties represented in the study include mental health, family practice, internal medicine, physical therapy and general practice. The report likely carries additional weight because half of the respondents are patient care professionals. The rest included office managers and administrators.
"In 2017, MACRA hit the ground running, and while CMS works frantically to ensure a smooth transition, it seems that healthcare professionals are closing their eyes and hoping someone slams on the brakes," the study authors noted. "Several recent surveys have documented the industry's sobering lack of technological preparedness and resources.
"However, we wanted to take a step back and get a sense of how healthcare professionals are feeling. We took the industry's temperature to see what healthcare professionals really think about MACRA."
Unfortunately, the majority of providers don't feel familiar with MACRA. "I'm not sure" was the most common answer NueMD received to every question in its survey, and only 9 percent consider themselves to be very familiar with MACRA and reporting started this year. Those are sobering statistics.
At the same time, eligibility is widely unknown. At the time of the survey, 56 percent of participants did not know whether they qualify to participate in MACRA's Quality Payment Program (QPP).
However, during the survey period, CMS issued notices to physicians by mail if they're expected participate in 2017. These numbers may have swung upward.
These same folks said MACRA information is not easy to find. In fact, 49 percent said have not encountered any information on MACRA, and 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 said, "I'm not sure." Only 9 percent feel it will have a positive impact.
Medicare Part B clinicians want to know how MACRA is going to affect their financial health. When asked practices to consider MACRA's effect on their financial well-being over the next three years, 61 percent said they have no idea; the rest were divided fairly evenly among a positive, negative or neutral outcome.
However, those who are MACRA-savvy predict good outcomes. 39 percent of those comfortable with MACRA believe it will have a positive impact on the financial well-being of their practice.
Administratively, when it comes to reporting, the majority of professionals (58 percent) have no idea how MACRA will impact their workflow, but of those who feel comfortable making a judgement call, 27 percent say they will spend more time reporting. Only 3 percent believe they will spend less time on reporting.
Regarding patient care, 62 percent of respondents weren't sure what the outcomes might be, while the rest were split between MACRA worsening, improving or doing nothing at all to impact the quality of patient care.
Those familiar with MACRA were also decisively split: Some expect patient care to worsen (30 percent), while others expect to see it improve (28 percent). Many also think patients and practices will have to shoulder more of the financial burden created by MACRA.
In sum: There's a lot of confusion and uncertainty about MACRA. Welcome to healthcare.
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