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Six Things to Understand About MACRA

April 1, 2021
April 1, 2021

HealthStream’s Second Opinions Podcast series features industry experts and leaders and their take on issues impacting healthcare today and tomorrow.

Earlier this year, we interviewed Dr. Miles Snowden, the Chief Medical Officer at TeamHealth. He shared his personal insight on the Medicare Access and CHIP Reauthorization Act (MACRA), and what it means for physicians, hospitals, and consumers. Dr. Snowden has seen a lot of changes throughout his career, but none so impactful as the implementation of the Merit-based Incentive Payment System (MIPS). Here are some of Dr. Snowden’s insights about MIPS and MACRA:

  1. Small practices will find it harder to survive.

    Based on the most recent available data, 47% of physicians still practice in groups of five or fewer physicians. A group of that size five or fewer would find that essentially impossible to be able to aggregate and report data and improve upon quality performance status sufficiently to avoid the very large penalties that will occur under the MIPS and MACRA program.

  2. The world of physicians will be fundamentally reorganized.

    MACRA is not just about an additional burden of reporting. This is a fundamental change in how physicians organize themselves.

  3. Older physicians may choose to retire when faced by multiple new conditions.

    As for the demographics of that group of physicians in the groups of five or fewer, they are much older on average than the physicians that constitute larger group practices. So you have half of the country's nearly a million physicians in very small groups, and they are approaching retirement. The other half is younger and more likely to work in large groups. The latter half will likely be somewhat more successful in the program, the former half will be the peer group contributing the funds that will allow the others to receive incentives essentially. So as you can imagine, if you have half of the population creating a pool of money to be given to the other half of the physician population, there's going to be a push to move from one side to the other side of that equation.

  4. Big changes can be expected in 2021.

    2021 will be the year of great surprises for physicians and a catalyst year for retirements, for movement to larger groups, and for various other changes that will forever essentially alter the practice of medicine.

  5. Doctor shortages will be exacerbated.

    Physician availability will be affected. We are already in a critical shortfall with for many specialties. We are going to drive out a good portion of those older physicians in those smaller groups that I've mentioned that comprise almost a half of our physician population in the US. We will significantly worsen the physician availability problem that we have today.

  6. Expect further consolidation of practices into larger groups.

    We'll see a consolidation dramatic in nature around larger group practices. And it's important to think of the fact that the individual physician is pulling their performance under the new MACRA and MIPS Programs, pulling their performance along with them, whereas in the past under our Value Modifier PQRS Programs that we have been working on through 2016, the physician only participates in the sense that they add their performance to the groups. It's the group's performance that is sustained over time. As a physician begins to pull their own individual performance forward, they are in essence undoing their own economic viability, uh, year after year. So the drive to mitigate low performance, low performance can be actual quality of practice or low performance can be the reporting of the quality of your practice. In either case, a physician can't sustain more than a couple of years of pulling forward unfavorable performance. They'll have to act fast. The consolidation of the physician practice market place into large groups is going to happen very quickly.