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    Is DPC a viable way to MACRA-proof your practice?

    Is the current economic model for the delivery of primary care services sustainable?

    In short: No. Today, an increasing number of primary care physicians (family practitioners, internists and pediatricians especially) who were previously thriving in private practice are considering a hospital-based practice or leaving primary care altogether.

    Continuous increases in overhead, decreasing reimbursement, never-ending paperwork and ever-growing intermediation on behalf of both health insurance companies and the federal government are all contributing factors to the sense of disillusionment and the financial distress felt by many of these physicians.


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    It is becoming readily apparent that the current model of providing healthcare, especially in the primary care setting, is not working.

    If the political will existed for the single payer option, would that be a viable solution? In all likelihood, the answer to this question would also be no. There is no guarantee that costs would be contained and that a crippling tax burden would not be imposed on already overtaxed citizens that would be necessary to support a substandard healthcare delivery model.

    With the most recent changes in physician reimbursement, known as MACRA (Medicare Access and CHIP Reauthorization Act of 2015), physicians are deeply concerned about the additional strain on their practice, from both a financial and clinical standpoint.

    As an example of the impact on the clinical side, a 2016 American Medical Association study finds that a primary care physician currently spends two hours of administrative time for each one hour of patient time. This will no doubt increase as a result of efforts to understand and comply with the new guidelines associated with MACRA.

    While estimates of MACRA’s negative financial impact on physician practices range from 10% to 87%, the actual result remains to be seen. One certainty is that the additional cost of compliance with MACRA must be considered.


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    Access to care in the future is also of concern due to the increased pressure of intermediation.

    In fact, a recent study by physician employment firm Merritt Hawkins shows that job pressures like these have 48% of physicians planning to retire, cut back on patients or hours or seek non-clinical, administrative roles.

    In addition, despite having the most expensive healthcare system, the U.S. ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives, according to a 2014 Commonwealth Fund report. The U.S. stands out for having the highest costs and lowest performance among the nations listed in this report.

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    • [email protected]
      At age 59 and not ready to financially or emotionally retire, I think that if I were to stay in primary care I would go the direct pay route. Instead, I have chosen to semi-retire and do ER work 20 to 30 hours a week, and make much more than full time practice under the current system.. I believe that the future will see patients paying cash to see a physician, or else see a midlevel under their insurance. Sad days ahead if we continue to let things like MACRA and MIPS rule the world

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