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HealthStream’s First Second Opinions Podcast Focuses on MACRA and MIPS

HealthStream has just launched our Second Opinions Podcast series, where we will be talking to industry experts and leaders about 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:


Dr. Snowden, some have said MACRA and the new quality payment program will result in sweeping changes, not only in physician reimbursement but also to how physicians practice. Do you agree?

Dr. Snowden:

I think the market place as a whole has dramatically underestimated the impact of MACRA to the practice of medicine going forward. And while there has been a great deal of focus upon it, it has not been seen as the catalyst for a dramatic change in the organization of physicians to practice medicine. So I’m going to give you some context around that. Today 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 data and report data and improve upon quality performance status sufficient to avoid very large penalties under the MIPS and MACRA program.

So if you think about half of the 880,000 physicians  in the United States today being in groups of insufficient size to survive this change, you can begin to understand that this is not just about an additional burden of reporting. This is a fundamental change in how physicians organize themselves. It's also interesting to look at 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 the larger group practices. So you have half of the country's nearly a million physicians in very small groups, and they are older and approaching retirement. You have half younger and large groups. The latter half will be somewhat successful most likely 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 population, there's gonna be a push to move from one side to the other side of that equation.

So, thinking about MIPS as a catalyst for the reorganization of the practice of medicine not simply as an additional burden for physicians I think is the more insightful way to think about this change.


So thinking about this as a catalyst, these are pretty dramatic changes you are you talking about. When do you think physicians are going to begin feeling the impact?

Dr. Snowden:            

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 be forever essentially in the practice of medicine. The physicians that won't be surprised are those who have been active, successful participants in the Value Modifier PQRS Program. There are a number of us who have benefited, significantly by working hard to report accurately, comprehensively, and in a manner that allows the transparency amongst our physicians to allow them to improve their performance over time and therefore benefit from the incentives of the program. I would argue that these individuals will be well prepared for the MIPS program. And by virtue of the fact that you have two cohorts, a well prepared group that's moving into 2017 very purposefully and we are ready to advance your performance against a group that has ignored PQRS, creates a bipolar distribution and is the perfect set up for a large transfer of penalty dollars to incentive dollars in 2018 and beyond.

Now, CMS has wisely imposed some gates, some buffers on the transfer of dollars. So the transfer from low to high performing physicians will be less robust under the Value Modifier Program but it will be meaningful nevertheless and it will certainly be a surprise to those low performing doctors.

Listen to the podcast here.

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