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    Small practices likely to be ‘losers’ under MACRA


     “Independent groups are going to feel more vulnerable,” she says. “We’ll likely see even more of these physicians look to be employed … to meet these challenges, so there’s a lot of reason for concern. We’ve already seen a lot of interest in the merger and acquisition space [by independent practices] and this is likely to boost that interest.”

    Taking the first steps

    In addition to commenting on the proposed rule, Lund encourages independent practices to assume that their participation will be through the MIPS path and not its alternative, the advanced payment models (APMs). Even CMS estimates that only 4% of these practices would qualify for APM status and even then, they would need to report MIPS data.

    “Operate as if you are in the MIPS track,” she says.


    Tips: Finding the best MACRA rout to provider reimbursement


    Furthermore, she strongly advises practices not to try—in the next seven months or even shortly thereafter—to adopt an APM model such as an accountable care organization or participation in the Comprehensive Primary Care Plus program for the sole reason of APM track qualification.

    “It does not make sense to dramatically overhaul your payment model strategy,” she says. “It is too late and this is too dramatic a change.  And I don’t know it makes sense.”

    What practices can do is start focusing on quality reporting, especially the six measures identified under the quality category that will comprise 50% of a physician’s MIPS score.

    “Now is the time. There’s not a minute to waste,” Lund says.

    Under MIPS, in addition to quality, physicians are reimbursed based on their performance in three categories: cost, which replaces the current Value Based Modifier Program, at 10%; clinical practice improvement, at 15%; and advancing care information, replacing Meaningful Use and evaluating use of health IT initiatives, at 25% in year one of the initiative.

    Next: The biggest challenge

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      as expected, "affordable and quality value care" will kill the small independent practices, and the large ones will spend more to comply with MACRA, or whatever acronym system is next. In our area we are already seeing more doctors not accepting Medicare and this will only increase in the future.

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