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The Race to MACRA and Value

The Race to MACRA and Value

The 2016 Physicians Practice Physicians Compensation Survey shows that few doctors are being compensated for value-based care. Of 812 responding physicians, 67.6 percent say none of their compensation is tied to value-based care, and another 16 percent say it's less than 1 to 5 percent. Moreover, a clear majority or 72 percent say none of their compensation is tied to patient satisfaction metrics.

That will change, whether physicians like it or not. Medicare's new value-based reimbursement program is slated to begin in January 2017, with payment adjustments set to take place in 2019. CMS released its final ruling concerning the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in mid-October 2016, which will compensate physicians for quality-based metrics and patient outcomes under the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM) pathways. Yet, many industry experts say that a good number of physicians are not even sure what MACRA is, let alone willing to accept the paradigm shift that it requires.

Susanne Madden, founder and CEO of The Verden Group, a practice management consulting firm based in Nyack, N.Y., says physicians just don't understand the push to embrace value-based care. "When we talk about value, it's sort of 'value for who?'" she says. "Payers understand value because they are trying to get quality and outcomes for the amount of money that is being spent on healthcare. Physicians don't see it in the same way."

While it is easy to speak about bringing value, controlling cost, and improving quality of care for populations of patients, physicians are more intimately concerned with caring for each patient individually. This can set up an adversarial relationship with policy makers, economists, and even payers who are looking at healthcare more in terms of dollars and cents.

"The value is very cognitive, for most physicians, because it is about the relationship with the patient," says Madden. "So we are really talking about two radically different things from the perspective of each of the key players in this … [Physicians] are very physical, very tangible, not very economically focused and driven in the way that payers are," she says.

Why are physicians resistant to value-based care?

In our survey, only 30 percent of respondents say they expect their compensation will be lower in 2019 because of the changes that MACRA will bring, and 60 percent say they are not sure how MACRA will affect their practice revenue. While the government has essentially eliminated the negative payment adjustment in the first year that Medicare uses its new compensation formula (as long as physicians report a small amount of data in 2017), that will not be the case in subsequent years.

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