Why MACRA is bad news for smaller healthcare practices

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You might have read the title and wondered what is MACRA?

MACRA is an abbreviation of The Medicare Access and CHIP Reauthorization Act of 2015, which means, most importantly, that is a law which establishes new ways for physicians to be paid when caring for Medicare beneficiaries. This however is not the only reason for the law as it also includes funding for technical assistance to providers and quite a few more things.

So now that we know what MACRA is, why would it decimate private practice healthcare providers? Let us look into it. I’ve started by looking at the concerns of some private physicians.

First, this law will now start penalizing 7 out of 10 small (which is 1 to 2 physician practices) in the country. This will be because these practices will be overwhelmed complying with statistical reporting demands, which have absolutely nothing to do with enhancing the quality of care. It will also interrupt the time a physician spends with each patient. Physicians see this as particularly worrisome.

Another main concern that physicians have is that the MACRA’s quality initiatives will be in favor of larger practices and create a burden for smaller practices. One of MACRA’s requirements is that practices participate in group reporting registries, which is much easier for larger practices to do. Doctors who work on their own will be able to avoid some cuts (best case scenario) but will not really get any financial benefits.

MIPS system is also a concern due to the fact that, even if your practice is a bit bigger than some of the smaller ones and even if you do everything to the book, you might still get a penalty rather than a bonus. Larger practices, in general, will receive more bonuses.

One more problem that small practices face is that MACRA requires software and technical support. That comes with a huge price tag, of course. Most small practices do not have even an IT department, let alone the funds required to employ the staff they’ll need to operate it.

This law will also push doctors to join Accountable Care Organizations (ACOs) and although many agree it might be reasonable in the long run, it is a bad idea for many reasons. The pilot Medicare ACOs, for example, have already failed. The CMS and similar organizations are still discussing the changes that need to be made in order to implement ACOs. In addition, the current policy allows doctors only one chance to join an ACO, giving them no options if they are rejected the first time.

Some physicians see MACRA as a bill which will penalize doctors who care for sicker, poorer, and older patients. Although this is not explicitly stated anywhere, it is likely that this will be the end result. Physicians who have small practices and go out of their way to help patients in desperate need face a higher likelihood of penalties and fines.

So is this law a good one?

Well, looking at this law from the perspective of big practices, this law will be a good thing. It appears that smaller practices will suffer quite a bit. Their patients, who cannot afford to see a doctor at a large practice, will suffer as well.

In the end, private practice physicians will either be financially forced to shut their doors or they will have to quit due to lack of autonomy and job satisfaction. This will also mean some doctors will have to join a large healthcare group to keep practicing and make it worth the time.