Half of non-pediatric physicians have never heard of the Medicare Access and CHIP Reauthorization Act of 2015—a new CMS payment plan that will put 4% or more of their Medicare reimbursement at risk beginning in 2019, according to a new survey by Deloitte.
With CMS preparing final rules this autumn, just 21% of self-employed or small-group physicians and 9% of physicians employed by hospitals or larger groups were even somewhat familiar with the pending reimbursement changes, the survey showed.
Physicians with a high share of Medicare payments were just as clueless about MACRA as those with lesser exposures, Deloitte found. The consultancy surveyed 600 physicians through its Deloitte Center for Health Solutions.
Physicians and other clinicians have been caught flat-footed by the “transformational” changes portended by MACRA because for 20 years they have heard about major impending Medicare reforms that never came to fruition, said Anne Phelps, Deloitte principal and U.S. healthcare regulatory leader.
“It was an annual dance,” she said of on-again, off-again reforms.
MACRA, however, is a different story, Phelps said.
When MACRA goes live in 2019, it promises bonuses for top-performing doctors and clinicians and penalties 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.
Medicare's own MACRA projections show the vast majority of physicians in groups of less than 10 suffering penalties.
That includes 87% of solo practitioners who can expect their reimbursement to fall and 70% of physicians in groups of two to nine, Medicare data show.
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 show.
The Deloitte survey found that though physicians were generally unaware of the details surrounding MACRA, they are attuned to new financial pressures coming their way.
About 58% of respondents said they would join a larger organization to diminish their financial risks. And 80% expected MACRA to prompt physicians to join larger organizations or networks.
Phelps cautioned that being employed by a hospital or one of the physician-staffing consolidators weren't their only options.
Many will join clinically integrated networks and other groups to gain access to the information technology and data needed to prove quality under the new reimbursement models, Phelps said.