The change in Medicare reimbursement currently in progress is a marked improvement, but the timeline for implementation is dangerously short and the regulations could be a death knell for small practices, physicians said Tuesday during the annual meeting of the American Hospital Association.
In a panel discussing the movement toward value-based payment for doctors and hospitals, Dr. Lee Sacks, executive vice president and chief medical officer for Advocate Health Care, said the changes required by the Medicare Access and CHIP Reauthorization Act cannot happen overnight.
“It will be too late if you start tomorrow,” he said. “This is really important.”
The CMS released a proposed rule last week outlining some of the MACRA regulations, including some information on what will qualify as an advanced alternative payment model and a new program for managing electronic health record systems.
Sacks said Advocate began a focus on improving quality and reducing costs—key parts of value-based payment—in 2008 and ramped up these methods as legislation began to explicitly embrace and encourage these efforts.
“We're all in,” he said. “We jumped in the deep end of the pool.”
Sacks said the Merit-based Incentive Payment System, one of the two paths that will be available to physicians when the rules go into effect, appears to be more of a competition mechanism than a way to award improvement.
He also said that it might be difficult to change providers' behavior because of the long period between their actions and the payment based on their value. He also said the lack of accounting for the socio-economic factors of the patient population is disappointing.
Still, he hopes providers and regulators can learn from their mistakes and “not let perfect get in the way of good,” he said.
Dr. Patrick Conway, acting CMS principal deputy administrator, said the agency looked at taking socio-economic factors more into account, but determined the law does not allow for that.
Sacks and Dr. Steven Stack, president of the American Medical Association, said specialty physicians and small practices could be particularly hard hit by the requirements of MIPS or an advanced alternative payment model.
“The challenge of survival for small practices is daunting, if I'm kind,” Stacks said, adding that it could be next to impossible with a more skeptical outlook.
They will struggle with acquiring the infrastructure for a qualifying EHR and the requirements for installing and maintaining it, Stacks said.
“Right now the technology has not yet supported (the sector of) the industry that it needs to,” he said.