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The MACRA muddle: a tipping point for independent physicians?

As the healthcare landscape continues to evolve in a way that makes it increasingly difficult for the independent physician to survive, we note with concern the latest challenge. Centers for Medicare and Medicaid Services’ (CMS) proposed rule for new value-based payments under the Medicare Access and CHIP Reauthorization Act (MACRA), has justifiably been called one of the most sweeping changes in years for physicians. Unfortunately for physicians in small practices, already struggling with financial, regulatory and emotional pressures, MACRA moves the needle in the wrong direction, benefiting large hospital groups and practices. We know the dialogue is just beginning, but we believe MACRA may prove to be a tipping point for independent physicians, forcing hard choices and spurring the search for alternative practice models before performance reporting goes into effect in 2017.

As long-time advocates for physicians who want to preserve their ability to practice medicine in an independent and sustainable model, we urge a closer look at the potential negative impact of the new MACRA ruling:

  • The estimated effects of the proposed Merit-based Incentive Payment System (MIPS) regulations will result in penalties for the vast majority (87%) of solo practitioners and those in practice of two to nine physicians in 2019. However, the ruling will reward 81% of practices with 100 or more physicians.
  • The burden of reporting Meaningful Use metrics will create difficulties for smaller practices, without access to staff and technology resources available to hospital and large practice groups.
  • The predicted 4% adjustment in Medicare payments could push physicians into leaving private practice or dropping Medicare – either option reduces access for patients in need of care.

“It appears the proposed rule would create a penalty system where the big guys (larger practices) will be funded by the little guys,” says Ingrid Lund, The Advisory Board Company.

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