Recently, there has been a lot of discussion about MACRA and the QPP, two programs designed to promote the growth of and expand access to primary care physicians, while improving quality. Despite all the healthcare industry media coverage on this topic, a 2016 survey from the, Physicians Foundation, revealed that of the 600,000 providers who participated, only 20% knew what the Medicare Access and Chip Re-authorization Act (MACRA) was. Furthermore, 33% of the participating doctors included in the survey identified themselves as independent or group practice owners, down from 48% in 2012.
Why the sudden 15% drop in such a brief period?
When asked about morale:
- 54% of providers rated their morale as negative
- Only 37% describe having positive feelings about the future of healthcare
- 49% have or were experiencing feelings of burnout
There is a correlation between morale and the care provided to patients. As stated by Ms. Sonda Eunus, founder of Leading Management Solutions, a consulting firm geared toward private practice providers, “When healthcare employees have low morale, it affects the quality of care provided to patients. We have to make sure that our staff is taken care of and that includes medical providers.”
Some additional concerns revealed in the survey were:
- 80% of doctors felt over extended and were unable to see any additional patients
- 72% were frustrated with the reimbursement process and other external factors
- 21% of their time is spent on non-clinical paper work, which reduces the amount of clinical time available.
With the continued decline in private practice physicians and growing demand for their services, can MACRA and the QPP help to reverse this?
First, what is MACRA and the QPP?
MACRA stands for the Medicare Access and CHIP Re-authorization Act; the re-authorization replaced the old Medicare reimbursement system with a new pay-for-performance model that emphasizes value, quality, and accountability in care. The goal is to allow healthcare providers to focus more on providing quality care versus having to provide multiple services to maximize reimbursement.
The Quality Payment Program or QPP helps to improve Medicare by focusing on quality and improving patients’ health. It allows providers to choose from one of two incentive programs based on their practice type, location, and patient population.
The two tracks are the Advanced Alternative Payment Model (APM) or the Merit-based Incentive Payment System (MIPS). The APM model is an innovative payment model for Medicare Part B participants, and MIPS is a performance based incentive model that combines three previous programs into one. The three previous programs were the:
- Physician Quality Reporting System (PQRS)
- Value-based Payment Modifier (VBM)
- Medicare Electronic Health Record (EHR)
The MIPS program utilizes a four-category score system to grade performance:
- Quality (50%)
- Use of Resources (10%)
- Meaningful use of EHR technology (25%)
- Documented clinical practice improvement activities (15%)
How does MACRA and the QPP Incentivize Providers?
The initial tracking period for providers started on 1 January 2017 and ends on December 31st; providers will have until March 31st, 2018 to report their data and earn up to a 5% incentive payment. According to Ms. Eunus, “Many practices today do not feel the urgency of complying with MACRA and QPP requirements because they believe that the program does not start until 2019, which is actually when the MIPS payment adjustment is made. What these practices do not realize is that the program has already started, and that their performance data is already being collected. It would be of great benefit for all physicians and other healthcare practitioners accepting Medicare plans to get familiar with the program as soon as possible—or they may face financial losses and negative performance feedback within the next few years.”
Private practice providers can earn incentive pay by monitoring and reporting data based on the requirements of their selected track. Mr. Ted Chan, founder of CareDash.com, a highly rated site that provides unbiased doctor reviews and resources for patients writes: “MACRA and the QPP specifically, has a flexibility and support for small practices addendum that was added on to the final MACRA law. It has a low volume threshold for practices that bill a small amount to Medicare, which a single doctor practice will likely do. The merit based incentive element (MIPS) has a lower level of requirements for smaller practices to achieve higher payments.”
Provider Concerns about MACRA and QPP
Some providers have valid concerns about QPP such as:
- How data will be abstracted
- Amount of time required to commit to reporting
- Inconsistency in data management
- A lack of support
- Necessity to benchmark practices
- Limited data to maximize reimbursement
Having a solid EMR system with data analytics can help to relieve some of these concerns on the front end. Per Mr. Chan, “Most EMR vendors now have the data collection and reporting modules built in, even the ones that a small practice would select. There are technical assistance grants via support organizations and practice transformation networks. Overall, I think new technology including EMRs, revenue cycle management and billing software, and web-driven marketing channels are why it's a good time to swim against the tide and go private practice.”
While there are some factors out of the hands of the provider; those that aggressively pursue these incentives along with reimbursement for other value-based programs, such as Medicare’s Chronic Care Management program, may be able to increase their profits, while providing patients with better quality care. According to Physicians Foundation survey, 71% of providers considered their relationships with patients the most satisfying part of their jobs; a values-based approach to care may provide opportunities for physicians to continue to build these relationships and expand their practice. When asked about his perspective on the topic, Dr. Keith Mankin a private practice Orthopedic Surgeon and cohost of the popular physician podcast, Peer Spectrum believes: “It's the right time because an independent physician will have the most flexibility to change in response to whatever alterations occur in the healthcare climate.”
MARCA and the QPP ultimately shifts the focus back to expanding primary care by offering incentives and opportunities for providers who have been long neglected. Although, there is still some work that must be done, it may be a step in the right direction when it comes encouraging providers to remain in private practice and helping to improve morale and physician burnout, along with the overall quality of care patients receive.