MACRA? What’s that?

It wouldn’t be surprising to learn that most Americans haven’t heard of the Medicare Access & CHIP Reauthorization Act (MACRA). It’s pretty much inside baseball-type stuff to anyone who doesn’t work in health care. However, it’s a bit surprising – it not alarming – that most physicians apparently know little to nothing about it.

According to a recent survey by Deloitte’s Center for Health Services, 50 percent of non-pediatric physicians haven’t heard of MACRA; another 32 percent only recognize the name. That means more than 8 in 10 percent physicians surveyed remain in the dark on a law that’s supposed to significantly impact their pocketbooks. Yikes!

Although most physicians are unaware of MACRA, at least some think its key tenets are good idea; many others would rather see the current fee-for-service reimbursement model remain in place. According to the Deloitte survey:

  • 79% don’t support tying compensation to quality.
  • 74% believe performance reporting to be burdensome.
  • 50% don’t support individual quality reporting as would be required under the Merit-Based Incentive Payment System (MIPS), one of the two major tracks in MACRA’s Quality Payment Program (QPP).
  • 80% prefer traditional fee-for-service or salary-based compensation as opposed to alternative payment options.
  • 71% would participate in value-based payment models if offered financial incentives to do so.

Physicians also remain skeptical as to whether MACRA will improve quality and lower costs. Of those surveyed who are unresponsive to incentives:

  • 9% felt that the law would reduce costs.
  • 5% said it would improve quality.
  • 23% support value-based payment models.

Regardless of whether physicians are ready for MACRA or support its major objectives, a chunk of law is just a few months away from taking effect.  The U.S. Centers for Medicare & Medicaid Services (CMS) released its proposed regulations for MACRA this spring, and the final regulations are expected in the fall. However, a delayed start remains a possibility. At a U.S. Senate hearing in early July, acting CMS Administrator Andy Slavitt said a MACRA postponement wasn’t out of the question, at least for smaller providers who lack to the resources required to follow the new quality reporting rules.

However, if everything does launches without delay, most physicians probably won’t feel either benefit or burn until 2019. That’s when Medicare reimbursements paid out to practices are supposed rise or fall by up to 4%.  Jan. 1 2017, marks the first day physicians can report the quality measures CMS will use to calculate the 2019 reimbursement increases or cuts. The reimbursements or penalties are scheduled to increase annually, capping off at 9% in 2022.

So why are physicians largely unaware of MACRA? For starters, it’s still relatively new. It also arrives on the heels on a period of hefty policy transformation in health care. A few years ago, meaningful use became law. Shortly after, the Affordable Care Act (ACA) was passed and signed; its key tenets, such as the Medicaid expansion and heath insurance exchanges, went into effect just a couple of years ago. It’s understandable if a good deal of fatigue with new health policy has set in among physicians. Many are busy enough trying to run their practices, and are challenged to sort through any sweeping government-imposed changes.

Most of the physicians Deloitte surveyed think MACRA will cause increased consolidation; in fact, 80 percent said it will drive doctors into larger organizations or networks.

Much will be revealed in the next few months. We should have CMS’ final set or rules, and perhaps news some type of delayed MACRA start.

For now, the MACRA mantra should be: Ready or not, here it comes.

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