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How Will MIPS and MACRA Affect Patient Satisfaction?

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.

In our first installment, we interview Dr. Miles Snowden, the Chief Medical Officer at TeamHealth. He shares 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.

Below is a short excerpt from the recording with HealthStream’s Brad Weeks, our host:

Brad:

What do you see as the impact [of MIPS and MACRA] on the patient experience…?

Dr. Snowden:

I am not at all certain that patient satisfaction with care will be improved. And, I think there is a reasonable argument to be made that satisfaction may diminish a bit under MIPS and MACRA. The quality metrics are very narrow, and they result in a very narrow focus. Patients like a very holistic engagement with their physician, a sense of taking care of the whole person or the whole family or the whole home. And these quality measures are not developed with a holistic approach nor could they be frankly at this point in time because how do you report them, in scale, at scale? So the narrowness of the quality measures are inconsistent with the holistic relationship that patients seek for full satisfaction.

So I don't think patient satisfaction will be improved, and it may be diminished, as a result of MIPS. On the other hand, most physicians will tell you some of the least satisfied patients have the best clinical outcomes and vice versa. And that probably holds true here as well. So while patient satisfaction probably won't be significantly improved under the program, clinical outcomes particularly longer term clinical outcomes, I suspect, will be improved.

For the next two or three years, there aren't going to be many patients that are thankful for the promulgation of the final rule for MACRA. Over the next decade or so, I think people will be able to point back and say, "Outcomes, particularly amongst chronic illnesses, did get impacted favorably."

Brad:  

We’ve talked a lot about potentially dire consequences to MIPS reporting and MACRA. What’s the upside?

Dr. Snowden:

It's easy to take a glass half empty approach to MIPS and MACRA, as a physician myself who is in the latter half rather than the first half of my career. I don't feel that way, and I don't see that amongst the physicians who make up our 19,000 clinicians. I see for the most part physicians who are energized and enthusiastic about their practice. I see physicians who generally are comfortable with the use of EMRs now, who are comfortable with being measured against peers, who are comfortable with being required to improve quality outcomes overtime, who are comfortable with supervising advanced practice clinicians, etc.

The physicians who are vocal about being unhappy with the practice of medicine either recently or certainly will be under the new MIPS burdens are generally those who frankly will be gone, with this change. They are in that half of the physician population in the US, 440,000 or so physicians in little groups, or older physicians who probably will look for opportunities to depart. Now that's not a good thing because of course these are highly experienced physicians, they will be terribly hard to replace. But when you think about the remaining physician workforce, these are younger physicians who never knew what it was like to practice medicine in the 80s and 90s. They don't have the context of the older physician who is bemoaning the loss or the way practice of medicine used to be. If you don't have the context of what the practice of medicine used to be, you don't miss it.

I think we have a generation of physicians who are actually very comfortable with more regulated, more peer comparison based practice of medicine. I like that. I think that having more of a team-based approach to healthcare, more of a collaboration based approach, more of a willingness to accept measurement against peer, is bound to improve the quality of medicine over time. And as we migrate to a generation of physicians who are comfortable with technology and EMRs and don't know how to use a pen on a paper chart, we'll see that general group satisfaction rise. And with that, outcomes and patient satisfaction should rise similarly.

Listen to the podcast here.