MACRA doesn’t spell end of independent medical practices
Despite the law’s far-reaching impact, many physicians remain unclear about what’s in it or unaware of it entirely, and panelists urged their peers to educate doctors about it. “All our clients need to realize that this is going to happen, and it starts in January 2017 [the date doctors will have to begin reporting quality data to CMS,] said Chris Zaenger, CHBC, principal of Z Management Consulting Group.
“It will affect their [Medicare] payments in 2019 and will have the same impact as a couple of years ago when everyone learned they were getting a payment adjustment because they didn’t pay attention to PQRS [the Physician Quality Reporting System]. Only this is going to be more painful because the percentages will be higher,” Zaenger said.
Panelist Ginny Martin, CMA, president of Healthcare Consulting Associates of N.W. Ohio, pointed out that MACRA is part of a larger effort to move healthcare away from its traditional fee-for-service model and towards value-based payments, an effort that includes commercial payers as well as Medicare. “This isn’t a Medicare [only] initiative, it’s a CMS initiative, and it’s being done in collaboration with commercial insurers,” she pointed out. “So it’s not going away.”
‘Provider Godzillas versus insurance King Kongs’
Turning to the subject of the ongoing consolidation among commercial payers, Zaenger said it’s being driven by payers’ desire to reduce costs and expand market shares, and to keep up with the expansion of health systems, which are themselves acquiring independent practices and hospitals in their geographic regions. “It’s provider Godzillas versus insurance King Kongs,” he said.
At many insurers, he added, customer service has suffered due to the companies’ rapid expansions. In helping his clients with tasks such as provider credentialing and getting questions answered about their contracts, “in every aspect I personally see it [service] breaking down,” Zaenger said.
Zaenger noted that the Federal Trade Commission has narrowed its definition of what constitutes an anti-competitive merger, and “it’s really changing the landscape of allowing larger entities to come together.”