87% of Practices Not Adding Staff for MACRA Implementation

May 31, 2017 - About 87 percent of physician practices do not plan on hiring additional healthcare staff to help with MACRA implementation, a recent Physicians Practice survey showed.

The survey of over 1,000 practice managers and physicians revealed that most practices anticipate training existing employees to facilitate the value-based reimbursement transition under MACRA implementation.

Another 19.2 percent of practices also stated that their budget does not allow for additional hires just for MACRA implementation.

While most physician practices are not in a position to take on additional staff members, a small percentage (12.8 percent) expect to add employees to facilitate MACRA implementation. The practices expect to hire in the following departments:

• Clinical with 55.2 percent

• Operational with 26.4 percent

• IT with 9.2 percent

• Finance with 8 percent

• Other with 1.2 percent

The survey also showed that not only are most physician practices reluctant to hire MACRA implementation staff, they are also operating with limited clinical and non-clinical employees. The following healthcare staffing positions saw employment rates drop among physician practices between 2016 and 2017:

• Number of practices with a registered nurse on staff dropped from 45.4 percent last year to just 35.5 percent

• Downtick in physician assistants from 32.8 percent of practices to 26.6 percent

• Decrease from 40.5 percent of practices with a nurse practitioner to 36.9 percent

• Reduction from 20 percent of practices with coordinators to 16.6 percent

As a result, the majority of physician practices (44.9 percent) employed one advanced practitioner, such as a physician assistant or nurse practitioner. Another 40.9 percent kept between two and five advanced practitioners on staff.

Despite substantial decreases in advanced practitioners in physician practices, most survey respondents stated that their practice did not reduce staff in the last year. Almost 41 percent said that their practice added staff and 38.2 percent reported that their practice has the same number of employees.

Only 21.1 percent stated that their practice downgraded the number of clinical and non-clinical staff on their team.

Non-clinical staff positions were the most likely to be let go in the past year. Billing managers were the top position to be removed, followed by front-desk staff with 56.7 percent of practices letting the position go, biller with 19.7 percent of practices, and medical records clerk with 10.2 percent of practices.

Out of the clinical positions, medical assistants left in about 46 percent of practices. Only 11 percent of practices eliminated a nurse practitioner positioned and another 10.2 percent let go a registered nurse.

In contrast, physician practices added more clinical staff to their teams. The top position hired in the past year was care coordinator, followed by medical assistant with 59.4 percent of practices, front-desk staff with 51 percent, nurse practitioner with 23.3 percent, and biller with 20.1 percent.

Most practices may have recently added more members to their teams, but the survey found that the greatest staffing challenge was increased workload. Practice managers and physicians also said that employees performing dual roles was another top obstacle.

Other major staffing challenges affecting physician practices in 2017 included:

• Staff training and skills substandard with 12.5 percent

• Lack of professionalism with 11.9 percent

• Low motivation with 8.5 percent

• Conflicts between employees with 7.6 percent

• Poor customer service with 3.1 percent

Additionally, researchers found that an overwhelming majority of practices have yet to implement value-based reimbursement models. Ninety-two percent said that their practice’s primary reimbursement method was traditional fee-for-service.

Only 1.6 percent of practices reported that their main compensation method was value-based reimbursement.

The percentage of revenue stemming from value-based reimbursement models may increase as the year goes on. MACRA’s Quality Payment Program launched earlier this year and 2017 performance will impact 2019 Medicare reimbursement.