MACRA 911: Will MACRA Destroy the Small Physician Practice?

The Centers for Medicare and Medicaid Services may be serving MACRA up as “part of a broader push toward value and quality,” but most small physician practices feel the federal regulation will more likely push them out of business, according to a new survey.

In a May survey by Black Book Market Research of 1,300 physician groups with five or less clinicians showed 67 percent of high Medicare-volume physicians said MACRA means “the end of their independence.” These practices believe they “will not have the technology, capital or staffing to sustain under the conditions of the Merit-based Incentive Payment System (MIPS).”

The survey also shows that a strong majority of smaller practices are struggling with reporting requirements, revenue collection, and competition from larger practices and physician networks:

  • 89 percent of respondents said they “expect to minimize Medicare volumes” to avoid having to submit reports for quality improvement activities or cost performance
  • 77 percent said they currently are financially struggling “due to physician staffing losses to larger group practices and hospital integrated delivery networks”
  • 72 percent said they “blame their under-performing billing technology and compounding payment issues” for their financial woes

“Physician payment based on 2017 performance isn’t scheduled to kick in until 2019,” Doug Brown, managing partner of Black Book, said in a statement. “That’s far too long to maintain operations for the most stressed practices to hold on with outmoded technology and scarce billing support.”

Most small physician practices appear to agree. Nearly four-fifths of survey respondents (78 percent) said they anticipate joining a larger practice or network “to gain needed reporting, revenue cycle tools and support before 2019,” Black Book said.

However, the survey revealed that 63 percent of practices with fewer than 10 practitioners, as well as solo practice physicians, have still not settled on a technology suite or set of products that delivers to their expectations on Meaningful Use, clinician usability, interoperability and coordinated billing and claims. But over a third of those slower adopters expect to make product decisions before the end of this calendar year.

American Medical Association President Dr. Andrew Gurman is a solo-practice orthopedic hand surgeon who doesn’t use an EHR, according to MD Magazine.

“I don’t have an EHR,” Dr. Gurman told MD Magazine. “I just take the penalties.”

MACRA’s payment adjustments are scheduled to begin in January, and CMS has already made moves to help small practice physicians. HHS recently announced it will award $100 million over the next five years to organizations that provide support and training to Medicare physicians in group practices with 15 or fewer clinicians to comply with MACRA.

The Medical Association is studying the proposed rule and may provide comments particularly on those provisions of the rule of most significance to smaller practices. The timeline of the implementation of MACRA is of the utmost importance in that physicians will begin reporting Jan. 1, 2017, which will affect Medicare payments in 2019. The Association will provide more information as it becomes available.

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