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Physicians: MACRA Threatens Small Independent Practices

By HealthLeaders Media News  
   June 14, 2016

Nine out of ten solo practices plan to minimize Medicare volume to avoid filing quality and clinical practice improvement reports or cost performance reports to CMS, survey data finds.

Federal legislation that aims to improve healthcare quality and reward those improvements with incentives tied to reporting bodes ill for the dwindling supply of small physicians practices that accept Medicare.

The culprit is the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA), which passed in 2015.

A BlackBook Research survey of 1,300 physician groups of five or fewer clinicians found 67% of such physician practices believe their independence will end with MACRA.

Solo practitioners make up 17% of physician practices; 22% of physicians work in practices of no more than four doctors, according to the AMA.


Related: 3 Ways to Prep Physicians for MACRA's Unknowns


The Centers for Medicare & Medicaid Services is in the midst of reaching out to small practices get up to speed with MACRA, which will begin to affect Medicare payments in January 2017.  

Despite this, the BlackBook survey, conducted in May, found that 89% of solo practices plan to minimize Medicare volume to avoid filing quality and clinical practice improvement reports or cost performance reports to CMS.

More than three out of four (77%) of physician practices are struggling financially, the BlackBook survey found.

"Physician payment based on 2017 performance isn't scheduled to kick in until 2019," said BlackBook managing partner Doug Brown in a media statement.

"That's far too long to maintain operations for the most-stressed practices to hold on with outmoded technology and scarce billing support."

Before 2019, 78% of independent primary care physicians surveyed expect to join a bigger group or integrated delivery network (IDN) to access reporting and revenue cycle tools and support, BlackBook found.

Of practices with 10 or fewer practitioners, 63% remain unsure which health information technology and products meet their needs for meaningful use, clinician usability, interoperability and coordinated claims and billing, the survey found.

A full 55% plan not to make any technology shifts or purchases until they decide whether to be acquired by larger practices or IDNs.

Comments on CMS's proposed rulemaking on MACRA are due to CMS on Monday, June 27. CMS is accepting comments electronically.

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