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    How physicians can deal with policy uncertainty


    “No matter your political views, at the end of the day, [Trump] has run very successful businesses,” he says. “So in a business sense, things have to be cut and curtailed and I understand that. So I have a little wide-eyed optimism.”


    Going into ‘survival mode’

    While Davis awaits the Trump Administration’s next move, she is also anxiously anticipating word from the Centers for Medicare & Medicaid Services (CMS) regarding her future reimbursement. Under the Medicare Access & CHIP Reauthorization Act (MACRA), practices like hers, with $30,000 or less in Medicare Part B charges, are exempt from data reporting provisions.


    Further reading: What a Gorsuch Supreme Court appointment could mean to healthcare


    “I’m still awaiting my ‘golden letter’ from CMS regarding my MACRA exemption,” she says. “By my records, I should be exempt … but what we have and what Medicare has for us is often incongruent.”

    Davis has been on the phone with CMS frequently, starting in December 2016 when letters to qualifying providers were supposed to arrive. CMS then told her she’d find out in January, then that the letters were to come through Medicare Audit Contractors, so there would be yet another delay.

    More recently, a CMS help desk attendant told her, “toward the beginning of February.” As of press date, Davis is still unaware if she needs to provide quality metrics or not. “For something that went into effect on January 1, this is quite a delay,” she says. “I have to pay salaries and there are other issues.”

    Those other issues include replacing broken lab equipment and updating her practice’s electronic health record (EHR) system. Given the uncertainty of what’s ahead, both investments are on hold. Davis has also called her bank to ensure her line of credit is secure and to indicate that she might have to use it in the near future.

    Davis likens the current feeling to what used to be the annual uncertainty of whether Medicare’s Sustainable Growth Rate (SGR) would take effect—bringing double-digit reimbursement cuts to physicians—or Congress would delay the cuts for another year.

    “You have to go into protection mode, like we did pre-Obamacare and with the SGR,” she says. “You go back into that survival mode.” 


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