Understanding MACRA – Part 2/2

MACRA Defined: The Challenges

Now that we have a clearer picture of what the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will look like in practical form, it’s time to address just a few of the challenges that implementation will bring


Probably the biggest complaint in the comment sections on the many, many blog posts that have been written about MACRA is the cost of implementation.

It’s another rest of rules and criteria. A new set of standards. Which, in turn, will cost money.

That doesn’t have many doctors — especially those with small, private practices — very happy.

“Implementation will cost billions to taxpayers and will penalize competent and hard-working physicians who don’t have time to jump through government hoops to extract a fraction of what they need to survive financially,” one commenter wrote (https://ehrintelligence.com/news/proposed-macra-rule-to-end-meaningful-use-for-physicians).

Another commenter said that the new rules could have an even more drastic effect: “These regulations will hasten the retirement of many valuable and experienced clinicians who are not impressed with the glitz of the new wave technological changes including the often inferior electronic medical records.”

Short Timeline

The timeline for implementation as set by the Centers for Medicare and Medicaid Services (CMS) is January 1, 2017. That’s not a lot of time, especially with the open comment period not concluding until the end of June.

In fact, many organizations are doubtful that the deadline can be achieved.

The Healthcare Information and Management Systems Society (HIMSS) Government Relations Team has called the deadline “unrealistic.”

“Trying to implement something beginning January 1, 2017, I think is going to be challenging for a lot of different providers,” said Jeff Coughlin, a senior director at HIMSS, according to an article from HealthDataManagement.com (http://www.healthdatamanagement.com/news/is-the-new-mips-payment-system-deadline-too-challenging).

And, of course, the short timeline does nothing to help the cost issues mentioned previously.

Low Morale

It’s a challenge that often flies under the radar, but it’s a very real thing — physician morale right now is low. In an town hall meeting held in early May, many members of the American Academy of Family Physicians (AAFP) shared their dissatisfaction and unhappiness (http://www.aafp.org/news/macra-ready/20160510aclf-macra.html).

“When a nurse practitioner gets $300 for spending five minutes with a cardiology patient and I get $80 for half an hour, something is deeply flawed,” said Laurel Dallmeyer, a physician based in New York. Dallmeyer added that three of the four physicians as well as nurse practitioners have left her practice.

“We’ve heard you say you are looking at areas where you are overpaying, but we’ve never heard you say you’re looking for areas where you are underpaying,” said Lloyd Van Winkle, a physician from Texas. “The solution you’re looking for is in this room. What are you doing about underpayment? You are losing the base that is the source of your success.”

Even CMS Acting Administrator Andy Slavitt, who participated in the town hall along with CMS Deputy Chief of Staff Tim Gronniger, acknowledged that the meeting was happening at a time with “record low physician morale,” much of which caused by regulations and reimbursement issues.

If nothing else, the AAFP town hall showed that CMS has a long way to go to win over the full support of many physicians.

So, the hurdles for MACRA are evident. We’ll know a lot more about implementation after the commenting deadline ends, as CMS will update the rule sometime thereafter. Stay tuned.

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