LAS VEGAS — Doctor consolidation could be a consequence of physician and clinician reimbursement changes portended by the Medicare Access and CHIP Reauthorization Act of 2015, a reimbursement expert told a healthcare finance conference this week.
MACRA, which can boost or cut physician reimbursement depending on quality performance and other measures, is expected to hit small physician practices hard, Premier Vice President Danielle Lloyd told attendees at a session of the Healthcare Financial Management Association annual conference Tuesday.
It's not because they don't provide quality care. Instead they'll have a harder time than bigger groups obtaining the information technology and data needed to demonstrate that quality, Lloyd said.
The solo practitioner, she said, “will be negatively impacted.”
When MACRA goes live in 2019, it promises bonuses for top-performing doctors and clinicians and negative incentives for underperformers on a variety of measures, especially quality of care.
MACRA has two payment tracks. Clinicians in advanced alternative payment models can earn bonuses annually of 5%.
The majority of physicians, though, will participate in the Merit-based Incentive Payment System. On that track, physicians can earn plus or minus 4% of reimbursement in 2019, 5% in 2020, 7% in 2021 and 9% in 2022.
Lloyd shared Medicare projections that showed the vast majority of physicians in groups of less than 10 suffering negative incentives.
When MACRA rates hit in 2019, 87% of solo practitioners can expect their reimbursement to fall and 70% of physicians in groups of two to nine, the data showed.
Meanwhile, 55% of physicians in groups of 25 to 99 can expect to see their reimbursement rise, with 81% of physicians in groups of more than 100 anticipated to get a reimbursement boost from MACRA, the data showed.
Lloyd said many solo practitioners—and members of small groups—haven't been tracking quality metrics closely over the years and may not want to put all those systems in place under the new physician-reimbursement model. Even at 4%, physicians receiving reimbursement cuts at that level will feel the pain, she said.
That's liable to push some physicians to join other groups or become employed by hospital systems. She said other physicians may join clinically integrated networks in their areas that will provide access to data and technology while remaining independent.
During Lloyd's presentation, audience members remarked that some physicians may just retire rather than go through that dislocation.
What lends particular urgency to MACRA is that funding is revenue-neutral, said John Shewell, vice president of Healthcare Analytics at McKesson Corp.
That means that whatever the CMS pays in bonuses to some physicians, it will cut from underperformers to keep the cost of the program from rising, Shewell said.
Access to data becomes crucial under those circumstances, said Shewell, who spoke at McKesson's booth in the exhibition hall of the conference.
“You need data to win,” Shewell said.
