Are physicians ready for MACRA and its changes?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) aims to fundamentally shift the US health care system to make major cost and quality improvements. MACRA changes physicians' payment under Medicare and will likely influence other payers' physician payment strategies. MACRA's first performance reporting period is currently proposed to begin January 1, 2017. Understanding the law, physicians' awareness about the law, and all the changes it will bring can help all stakeholders determine which strategies to implement to help succeed under MACRA.

The Deloitte Center for Health Solutions 2016 Survey of US Physicians sheds light on physicians' awareness of MACRA, their perspectives on its implications, and their readiness for change. The survey is a nationally representative sample of 600 primary care and specialty physicians who were asked about a range of topics on value-based payment models, consolidation, and health information technology (HIT). This year the survey queried a subsample of 523 physicians (nonpediatric specialties) about MACRA.

• The survey found that many physicians are unaware of MACRA. Many also realize they likely will have to make changes to their practice to succeed under it; recognize they will need to bear increased financial risk; and understand they will require resources and support to develop the capabilities to do so. Of the surveyed physicians:
• Fifty percent say they have never heard of the law and 32 percent recognize it by name but are not familiar with its requirements.
• Twenty-one percent of self-employed or independent physicians say they are somewhat familiar with the law, compared to nine percent of physicians employed by hospitals, health systems, or medical groups owned by them.
• Eight-in-ten say they prefer traditional fee-for-service (FFS) or salary-based compensation as opposed to value-based payment models, some of which qualify under MACRA's alternative payment model (APM) track.
• Seventy-four percent of surveyed physicians believe that performance reporting is burdensome and 79 percent do not support tying compensation to quality, both requirements under MACRA.
• Fifty-eight percent of physicians say they would opt to be part of a larger organization to reduce individual increased financial risk and have access to supporting resources and capabilities.

The Deloitte Center for Health Solutions 2016 Survey of US Physicians found that, despite many reasons to learn about and prepare for MACRA, most physicians are still getting up to speed on this law that will likely change their Medicare payments. The survey findings suggest that the health care industry as a whole has a great deal of work to do with physicians to better prepare for MACRA and its impact. Multiple stakeholders— especially the Medicare program, physician organizations, and health systems—can support physicians as they work toward the common goal of delivering higher-quality and more cost-effective care.

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