A transformative law is on track to fundamentally change how physicians and other clinicians are reimbursed under the Medicare Physician Fee Schedule (PFS), but one-half of recently surveyed physicians have never heard of it, according to the "Deloitte Center for Health Solutions 2016 Survey of U.S. Physicians." The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) offers financial incentives for physicians and clinicians to move growing percentages of their practices to risk-bearing, coordinated-care models but, according to the survey, most physicians would have to change aspects of their practice to meet the law's requirements and do well under its incentives.
In addition to gauging awareness of MACRA, the nationally representative survey of 600 physicians asked their perspectives on the law's implications and their attitudes toward and readiness for change—change that will come in the form of new care models, new payment models, and new delivery models.
"The changes associated with MACRA are fast approaching," says Anne Phelps, principal at Deloitte & Touche LLP and US health care regulatory leader. "The first performance reporting period begins January 1, 2017. The fact that so many physicians and clinicians still haven't heard of the law means they'll have a lot of work to do over the next five months, including evaluating current payment processes and understanding how physicians are organized within their hospitals or practices."
Just 50% of nonpediatric physicians surveyed have heard of MACRA, for which the final rule is expected from the Centers for Medicare and Medicaid Services (CMS) this fall. Additionally, more self-employed physicians and those surveyed in independently-owned medical practices (21%)—as compared to surveyed physicians employed by hospitals, health systems, or medical groups owned by them (9%)—report that they are somewhat familiar with the law. The survey also found that physicians with a high share of Medicare payments are just as unaware of MACRA as others.
New incentives established by MACRA also will likely drive payment and delivery reform efforts across other payers. The law will allow clinicians to develop new care models and encourages new collaborations between plans and hospitals, but, according to the survey, nearly 8 in 10 physicians prefer traditional fee-for-service or salary as compensation. This means many physicians will likely have to adjust their current approach and practice management based upon MACRA's specifications.
"MACRA is what can make value-based care real," says Mitch Morris, principal at Deloitte Consulting LLP and leader for the health care industry at Deloitte. "It's exciting but also challenging. For example, while the survey found the majority of physicians believe that the performance of the US health care system can be improved by measuring care outcomes and processes and measuring resource utilization and costs, the survey also found most physicians believe performance reporting to be burdensome and don't support tying compensation to quality. These physicians will likely have to change aspects of their practices to meet new reporting requirements."
Perhaps one of the biggest changes physicians will have to consider is the need to bear increased financial risk. The survey found that physicians recognize this need, under MACRA and in general. With that in mind, most physicians surveyed expect increased physician consolidation, due to general financial pressures. Many physicians surveyed (58%) said they would opt to be part of a larger organization to diminish individual physician risk and/or to have access to a full spectrum of resources and capabilities. Additionally, 80% of physicians surveyed expect MACRA to drive physicians to join larger organizations or networks.