- Despite the significance of its provisions, many healthcare providers are still unaware of MACRA and the federal government's plans to eliminate the sustainable growth rate and offer new alternative payment models to eligible clinicians beginning in 2017.
According to a recent survey from the Deliotte Center for Health Solutions, half of non-pediatric physicians said that they have never heard of MACRA. Out of the 600 physicians surveyed, only 32 percent recognized the name of the legislation.
Even physicians with a high proportion of Medicare payments were just as unaware of MACRA as other participants, stated the survey.
“The changes associated with MACRA are fast approaching,” said Anne Phelps, Principal and US Healthcare Regulatory Leader at Deloitte and Touche LLP. “The fact that so many physicians and clinicians still haven't heard of the law means they'll have a lot of work to do over the next five months, including evaluating current payment processes and understanding how physicians are organized within their hospitals or practices.”
The survey found that self-employed providers and those who owned an independent medical practice were more likely to be somewhat familiar with MACRA (21 percent) compared to only 9 percent of employed physicians.
Researchers explained that self-employed and independent physicians have more direct responsibility for their business requirements compared to other providers, which contributed to more awareness of the program.
Despite meager awareness rates, many providers will have to change their practice management strategies to account for MACRA specifications in the upcoming months. This includes embracing value-based payment models, explained the survey.
Roughly eight in ten physicians stated that they prefer fee-for-service or salary for compensation over value-based care models.
A stronger preference for traditional payment methods may be linked to the administrative burden of performance reporting under value-based care models, such as MACRA. Nearly 74 percent of physicians reported that performance reporting was burdensome, while 79 percent did not support tying reimbursement to quality.
Specifically, about half of respondents did not agree with individual public quality reporting as required by the Merit-Based Incentive Payment System track of MACRA.
The survey also explained that more practices will need to modify management techniques in order to bear more financial risk under MACRA implementation. But, respondents agreed that their practices will need new capabilities in order to successfully enter into increased risk arrangements.
The top needed supporting capability was standardization of quality measures (42 percent), followed by analytics and other monitoring tools to track high-cost patients (29 percent) and standardization of cost measures (28 percent).
Researchers also indicated that practice acquisitions may increase in response to more financial risk requirements under MACRA.
The majority of participants (58 percent) stated that they would consider joining a larger healthcare organization to reduce individual physician risk and bear financial risk collectively under alternative payment models. Merging with a larger system would also increase access to more value-based care resources and capabilities, the respondents explained.
In general, 80 percent of those surveyed expect MACRA to drive providers to merge with larger healthcare organizations and networks due to financial pressures. The participants agreed that about a third or two-thirds of remaining independent physicians are likely to consolidate in the next three years.
While many providers opposed MACRA implementation, some participants expressed a willingness to participate in the upcoming Medicare payment models.
Nearly 71 percent said they would participate in value-based payment models if offered more financial incentives, while over half of participants would opt for shared savings arrangements even though they do not qualify as Advanced Alternative Payment Models under MACRA.
Additionally, participants who were more open to value-based payment models reported more positive expectations for MACRA.
About 23 percent of those willing to participate in value-based reimbursement arrangements with financial incentives expected MACRA to reduce healthcare costs, while 19 percent said it would improve care quality.
Almost half of this group also stated that value-based payment models could improve the overall performance of the healthcare system.
Of those providers who were unresponsive to value-based care incentives, only nine percent expected MACRA implementation to reduce costs and five percent said it would improve quality.
Many healthcare stakeholders believe the impact of MACRA implementation will pervade the entire healthcare industry, not just Medicare physicians. As the survey explained, new incentives created by MACRA are likely to drive payment and care delivery reform across all payers.
Therefore, all physicians, even non-believers in value-based care, may need to familiarize their practices with MACRA legislation before the January 2017 launch.