GAO: Small and rural practices will struggle with MACRA

For an industry traditionally scrutinized for low executive pay, one has to wonder what our executives are actually making.
A GAO report finds small and rural physician practices face obstacles to MACRA participation.

With smaller budgets and fewer resources, small and rural physician practices face greater challenges to participate in Medicare’s value-based payment models, including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to a new Government Accountability Office (GAO) report.

As Medicare moves to value-based payment models, which requires doctors to take steps such as using electronic health records to better track and evaluate patient care, small and rural physician practices are less prepared for the transition, the GAO review found.

For example, since many practices don't have big operating budgets, it is harder for them to invest in the training and technology they need to participate, according to the GAO report (PDF). And not all of the practices have access to organizations—group practices, private companies, nonprofit groups and universities—that can help them share staff and informational technology systems.

The GAO defined small practices as those with 15 or fewer physicians and rural practices as those located outside of an urban area.

Beginning in 2017, the Centers for Medicare & Medicaid Services will put in place a new payment system to implement MACRA. The MACRA law included a provision that the GAO look at organizations that can help small physician practices participate in value-based payment models.

But the report noted that small and rural practices may not be able to partner with organizations that can share financial risk and provide services, such as sharing data systems and care management staff, that can mitigate challenges. They may also lack access to non-partner organizations, which—while they do not share financial risk—can provide services that can help with health IT and data challenges.

The GAO zeroed in on five areas that will likely present challenges to these small and rural practices:

Financial resources and risk management. Practices may lack the money to make initial investments, such as EHR systems, and it may take years before they recoup their investment.

Health IT and data. Practices need to hire and train staff, as well as develop experience using EHR systems and analyzing data, to participate in value-based payment models.

Population health management care delivery. The patient populations in diverse geographic locations can affect practices’ ability to manage their care, especially in rural areas where patients may have to travel long distances.

Quality and efficiency performance measurement and reporting. Practices with small patient populations may find that measurement of quality and efficiency may be more easily skewed by patients who require more or more expensive care.

Effects of model participation and managing compliance with requirements. Practices with less staff have difficulty balancing and finding time for direct patient care, care management activities and additional administrative duties

Despite these challenges, and the fact that the political climate is uncertain, outgoing CMS head Andrew Slavitt has said MACRA, which passed with bipartisan support, is not going to go away and practices should prepare to participate in the new payment system.