Independent and rural practices still worried about their fate under MACRA

CMS

The looming changes to the way Medicare reimburses physicians continue to stoke fears of financial calamity for small, rural and solo practices, according to an article in the Washington Post.

Since the Centers for Medicare & Medicaid Services (CMS) laid out its proposed rule under the Medicare Access and CHIP Reauthorization Act (MACRA), industry voices have raised concerns about its impact on small practices, adding fuel to widespread calls for further delays in its implementation, as FiercePracticeManagement has been reporting. Congress passed the rule as part of a move to change Medicare’s payment model in a bid to shift incentives that currently cause unnecessary cost and waste in the system, says Tim Gronniger, CMS’s deputy chief of staff.

But many doctors worry about the impact. “We’re struggling to survive. Our kind of practice is dying in this country, and medicine itself is changing so rapidly that doctors everywhere seem to be burning out,” Lee Gross, M.D., who is part of the last small, independent family practice in North Port, Florida, told the newspaper.

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The requirements under the new payment plans will make life much more difficult for smaller practices than it will for larger ones for two main reasons, according to the article:

  • The rule rewards “exceptional” performers, and pays for those rewards by penalizing those who perform poorly against CMS’ standards, but the rule’s current structure is biased toward large practices and against small ones, said Paul Ginsburg, director of the Center for Health Policy at the Brookings Institution.
  • In order for small practices to comply with the rule, they will need to ramp up their administrative capabilities in order to collect, analyze and submit quality-of-care metrics to CMS, which is likely to impose a burden both in terms of technological capacity and human resources, according to the article.

While CMS has made some changes to the law already in order to reduce the burden on physicians, among other groups, the American Medical Association continues to push for delaying the start date from January 2017 until at least July, declaring in a statement that the rule must “accommodate the needs of physicians in rural, solo or small practices in order to enhance their opportunities for success and avoid unintended consequences.”

- read the article

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