Be Careful of the Solutions You Create – They May Be Worse than the Problems You Were Trying to Solve!

By Nitin Thakor, GeBBS President & CEO

Some lawmakers are warning the CMS that its Medicare Access and CHIP Reauthorization Act (MACRA) draft rule on new physician payments could significantly harm small physician practices. When MACRA goes live in 2019, it is supposed to improve healthcare delivery by giving bonuses to top-performing doctors and clinicians and provide negative incentives for underperformers on a variety of measures, especially quality of care. However, many people in the healthcare industry believe that MACRA will have a net negative effect on care delivery and cause many small practices to close their doors or consolidate with other practices, which will undoubtedly lead to higher healthcare costs.

CMS wants providers to report quality measures on 90% of their patients from all payers, and 80% of Medicare patients. Currently, only 50% of Medicare patients are required. Small physician groups will have a much harder time obtaining the information technology and data needed to demonstrate that quality.

Many small independent practices fear they may not survive the new MACRA legislation, as it stands today. A Black Book survey conducted in May 2016 with 1,300 physicians found that 89 percent of physician practices surveyed planned to reduce the number of Medicare cases they take on in order to reduce the reporting burden.

How does this improve the delivery or quality of healthcare?

Small physician practices have concerns about having adequate staffing in order to accomplish necessary reporting for MACRA. It’s very complex — 962 pages. Many small providers are currently struggling under already-existing governmental reporting policies.

The American Hospital Association (AHA) has also raised concerns about the unintended consequences of MACRA implementation. AHA Senior Vice President of Public Policy, Ashley Thompson, said that the proposed rule for MACRA implementation carries with it high costs for compliance for both hospitals and physicians. According to Ms. Thompson, what might happen is solo practitioners or those in small group settings might come to hospitals asking for employment opportunities. She also stated that there will be a number of physician retirements and some who just throw up their hands and say, “I can’t really do this.”

Again, how will this improve healthcare delivery?

The Black Book survey, mentioned earlier, also found that more than three out of four (77%) of physician practices are already struggling financially. How can requiring more compliance reporting help these struggling providers?

Whether or not CMS will heed any of these concerns is unclear. The agency sent the final rule to the Office of Management and Budget on September 16. That is one of the last steps before approval. The CMS expects to release the final rule by Nov. 1. It is my sincere hope that CMS will slow down in their MACRA efforts to improve the delivery and quality of care, and “not kill the patient.”