Over the past three weeks, I’ve had the chance to present the changes being brought by the Medicare Access and CHIP Reauthorization Act (MACRA) to audiences of hundreds of physicians—at ACP’s Leadership Day on Capitol Hill, ACP’s Board of Governors and Board of Regents meetings, several educational sessions and a news briefing at the College’s Internal Medicine 2016 Scientific Meeting, and on Saturday, to the California Medical Association’s Leadership Academy. I’ve also had chats with dozens of physicians outside of these formal presentations. Here’s what I have learned: most physicians look at the “value-based” payment reforms being brought by MACRA with a degree of trepidation: they aren’t sure how to proceed, what measures will be used, whether they will be unfairly penalized for things outside of their control, and worried it will result in more administrative “hassles.” It is certainly true that MACRA will make significant changes in the way physicians are reimbursed by Medicare, and ACP is addressing such concerns, through our advocacy with CMS and Congress, by our members about MACRA and by helping them be prepared. For instance, ACP has developed a two-page of the law, recommended 10 physicians can take right now, and developed implementation to help them. Understandable anxiety and trepidation is one thing, but what worries me is that there is a growing undercurrent (just Google “MACRA will destroy private practice”) that implementation of the law will be a “sky-is-falling, end-of-medicine-as-we-know-it” type of disruption. Frankly, this is nonsense, because MACRA offers physicians far more flexibility and choices than what that they currently have to put up with. Remember, MACRA didn’t create the idea of linking Medicare payments to measure of value, physicians have had to report on quality measures for years, with their payments being adjusted upward (and increasingly downward) if they don’t report successfully. So the real question is, is MACRA better than what doctors currently have to put up with PQRS, Meaningful Use, and Value-Modifier programs? So yes, MACRA is a big deal, but not in the way many physicians think it is. Compared to what physicians are currently dealing with under the current Medicare reporting programs, MACRA offers more opportunities for physicians to earn positive adjustments, exposes physicians to less risk from negative adjustments through 2021, creates positive rewards for the thousands of physicians who are practicing in certified PCMHs or who choose to get such certification, keeps all of the money from downward adjustments in the physician payment pool rather than letting Medicare keep it, and creates very substantial payment rewards for physicians in advanced Alternative Payment Models. These changes are all good for physicians, especially those in smaller practices. And, don’t forget, because of MACRA, we no longer have to deal with the annual SGR cut and all of its associated baggage. Sure, MACRA remains a work-in-progress; more can and must be done to simplify reporting and create additional options and flexibility for physicians in all types and sizes of practice, and physicians will need help in making the necessary changes in their practices. But even as it stands right now, MACRA clearly is a change for the better compared to what physicians currently have to deal with. Today’s question: what do you think the impact of MACRA will be on your practice?
The U.S. Medicare Access and CHIP Reauthorization Act (MACRA) is a proposed set of changes that have serious implications in terms of reimbursement for medical professionals. A discussion about these changes can be viewed on the American College of Physicians (ACP) Advocacy blog, written by its senior vice-president Bob Doherty who understands the concerns physicians have about 'value-based' payment reforms instigated by MACRA and whether it means increased bureaucracy and workloads. These concerns have been voiced on across news sites and social media to the extent that physicians are increasingly viewing the reforms in a hostile light; they seem them as having a negative impact upon private practice whereas Doherty argues that the reverse is true. The MACRA reforms mean that physicians will have greater flexibility and choice.