In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), which has been called the "most substantive change to how healthcare is paid for in a couple of decades" by no less an authority than the U.S. Department of Health and Human Services' former National Coordinator for Health Information Technology.
Yet, a number of recent surveys have shown that most physicians are still largely unaware of these groundbreaking new regulations. With that in mind, we ask the question: What is MACRA, exactly, and what do physicians need to know about it?
What Is MACRA?
Also called the "Permanent Doc Fix," MACRA was an effort to do away with the annual “Doc Fix,” — what The Federalist's Dustin Siggins calls "Congress’ annual tradition of delaying scheduled payment cuts to Medicare doctors."
"Created in 1997, the Sustainable Growth Rate (SGR) formula was designed in such a way that if Medicare’s costs grew too much, automatic cuts to Medicare doctor payments would take place," Siggins explains. "The costs have risen exponentially. However, Congress has continuously overridden this law since 2003, creating a so-called “Doc Fix” nearly 20 times in the last 12 years."
Clearly, then, a solution was needed, and many are thankful for MACRA's deliverance from what Massachusetts Medical Society President Dennis M. Dimitri, MD calls “the threat of 20–30 percent cuts in payment hanging over our heads.”
“We have finally and completely replaced the flawed SGR formula,” Dr. Dimitri says, calling MACRA “very important for creating an appropriate future work force of physicians.”
On net balance, then, MACRA is a positive for physicians and for the healthcare industry, representing a solution to a pressing problem. And, though its main effects don't kick in until 2019, it has already partially gone into effect, and will continue to be phased in through 2026.
Yet MACRA is almost indescribably complex, requiring either an innate knowledge of such things as Medicare payment structures, Children’s Health Insurance Program (CHIP), and the National Health Service Corps, or a deep study thereof. It's of little surprise, then, that many doctors are wholly unfamiliar with these new provisions.
As a recent survey from physician recruitment firm Merritt Hawkins has revealed, just 20 percent of physicians are actually familiar with MACRA. (The specific numbers are even more stark, with less than 6 percent of the more than 17,000 surveyed physicians stating that they're very familiar with MACRA.)
How Familiar Are Physicians with MACRA?
Very Familiar: 5.9%
Somewhat Familiar: 14.0%
Neither Familiar nor Unfamiliar: 23.8%
Somewhat Unfamiliar: 22.9%
Very Unfamiliar: 33.4%
Source: 2016 Survey of America's Physicians: Practice Patterns & Perspectives, conducted on behalf of The Physicians Foundation by Merritt Hawkins.
In addition, the Deloitte Center for Health Solutions 2016 Survey of US Physicians found that, "despite many reasons to learn about and prepare for MACRA, most physicians are still getting up to speed on this law that will likely change their Medicare payments," as Modern Healthcare reports.
Of course, this makes sense, somewhat, as doctors who aren't responsible for the burden of billing and payments — those who are wholly employed by hospitals or other employers, for instance, or those who work full-time as locum physicians with companies like Staff Care — may have little reason to face these admittedly complex changes. (And presumably have enough on their hands already without taking the time to familiarize themselves with these complex new regulations.)
For those physicians who run a private practice, however, there's certainly a sound reason to get acquainted with the intricacies of MACRA. (For everyone else, too, a general familiarity with these things certainly won't be amiss.)
A Brief Summary of MACRA & Suggestions for Further Reading
According to the American Academy of Family Physicians (AAFP), the basic facts of MACRA is that it not only repeals the previous Medicare sustainable growth rate (SGR) formula, but also "creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment."
These new payment tracks are broken down into a Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS "consolidates three existing quality-reporting programs: the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBPM), and meaningful use (MU)," the AAFP adds. "The system also adds a new performance category, called clinical practice improvement activities (CPIA). The four categories establish a composite performance score (0-100) that will be compared against a threshold and then used to determine physician payment adjustments."
The categories that comprise MIPS scores are quality (based on PQRS), resource use (based on VBPM), Advancing Care Information (ACI) (based on MU) and clinical practice improvement activities, which is a new performance category.
MACRA also consolidates the existing quality reporting programs ("Physician Quality Reporting System, Value-based Payment Modifier, and meaningful use") into a single system through MIPS, while adding an additional performance category.
Okay, let's take a breather — there's no doubt that MACRA is complex, requiring careful examination, and possibly even consultation with a financial specialist. "Multiple stakeholders — especially the Medicare program, physician organizations, and health systems — can support physicians as they work toward the common goal of delivering higher-quality and more cost-effective care," the Modern Healthcare report adds.
If you feel like you need a crash course in MACRA, the AAFP's overview is thorough and fairly easy to understand; we encourage you to view their overview here. We also recommend reviewing Deloitte's document "Are physicians ready for MACRA and its changes," available via Modern Healthcare.
If you're looking to make the shift to locum tenens work, we invite you to contact a Staff Care representative today. Known for being highly knowledgeable and industry-savvy — and friendly, as well — our locum tenens recruiters are equipped to help you discover the medical career path that best meets your professional needs and personal preferences.
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