CEO Power Panel: Are your physicians ready for reform?

Like it or not, ready or not, MACRA is coming.

Anxiety is rippling through the healthcare industry as the initial reporting period for Medicare's new payment system for physicians fast approaches. Modern Healthcare's latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by the law, formally titled the Medicare Access and CHIP Reauthorization Act.

This coming phase will be extremely painful for doctors, CEOs worry, even as they applaud the overarching goal of paying for healthcare on the basis of quality over quantity. They are keenly aware of the near-term challenges of managing these growing pains and of successfully mitigating potential negative consequences. But they are also optimistic—even confident—that patients and physicians stand to benefit in the long run.

“Right now, we're at the front end of all these new changes, and as we experience them over time we're going to find solutions,” AMGA CEO Donald Fisher said. The trade association, formerly called the American Medical Group Association, represents practices that include 170,000 physicians.

The CEO Power Panel surveys executives and leaders of hospitals, insurance companies, physician groups, trade associations and other not-for-profit advocacy groups. Of 117 queries sent, 93 responded to Modern Healthcare's third-quarter survey on MACRA, physician engagement and physician burnout.

The survey and follow-up interviews found wide variation in attitudes about how to proceed with MACRA amid varying levels of preparedness among physicians. The quality and efficiency of their care will be judged based on data collected starting in January even though the penalties and rewards under the law's two payment tracks won't kick in until 2019.

Respondents were split almost evenly when asked whether the CMS should delay that initial reporting period by a year. About 56% of respondents said yes, while the rest disagreed. Some who opposed waiting another year suggested delaying would be futile.

“I want to get going, so that we can get smarter and better and more effective at our quality and outcomes measures,” said Mary Brainerd, CEO of HealthPartners, an integrated hospital and health plan system in Minneapolis.

“It's going to be painful no matter when we do it,” said Julie Taylor, president and CEO of Alaska Regional Hospital. “I'm not seeing it get any easier by waiting.”

Life under MACRA will be more difficult for most physicians, especially those in small practices. And leaders in healthcare see it as their duty not merely to soften the blow, but to actually use MACRA as an opportunity to improve engagement, according to the survey.

More than 70% of the responding CEOs said they view the reporting requirements under MACRA as more burdensome than those of previous incentive programs for physicians, even though the structure was conceived in part to streamline those programs.

Nearly three-quarters said escalating penalties under MACRA would likely lead to greater stress for physicians. Nearly 82% said physician burnout is growing; 18% said it has remained constant.

MACRA makes physicians want to pull their hair out for many reasons. It gives them hundreds of quality measures to review and choose from, and it is ramping up at a time when other major changes are already underway in healthcare.

“This is probably the fastest rate of change in healthcare that I've seen in 44 years,” said Joel Allison, CEO of Baylor Scott & White Health, a Texas-based healthcare system. The acceleration is fueling stress, uncertainty and concerns that physicians will burn out, when in fact they should be enabled to practice at the highest level of their licenses, Allison added.

“It's imperative that leaders create that environment and provide the necessary resources—whether it's technology, new models of care, innovation—to allow them to do that,” Allison said.

Brainerd, of HealthPartners, said engagement is a matter of control. Physicians want to be able to shape their environment—and leaders want that, too. “Physicians really want to be connected to why they came to the practice of medicine in the first place,” Brainerd said.

Physician engagement is key for delivering value-based care, 99% of healthcare leaders said. Still, their ideas about building physician engagement diverged. About half said such engagement was the product of properly designed financial and performance incentives. Others prioritized hiring practices, transparency or public reporting.

Efforts to promote engagement were meeting with “some success,” about 64% of respondents said, while 18% said they had “a lot of success.”

Dr. William Conway, CEO of the Detroit-based Henry Ford Medical Group, described keeping physicians engaged as “constantly swimming upstream” against the demands of using electronic health records and federal requirements. “There are a lot of toxic side effects of these regulations,” he said.

As healthcare leaders work to make MACRA support rather than hinder physicians, they also will be watching to see how the new regulations reshape the healthcare landscape at large.

More than 91% expect continued consolidation as physicians seek to join larger systems that have the infrastructure to thrive under the new framework. Some leaders, nearly 42%, worry that physicians who find MACRA too burdensome will drop Medicare patients altogether.

In interviews, several CEOs shared anecdotes of older physicians who said they were considering simply ignoring MACRA's requirements and swallowing the penalties until they retire.

“We have two incentive systems that aren't necessarily aligned,” said Dr. Joseph Vasile, CEO of the Greater Rochester (N.Y.) Independent Practice Association. “We're trying to walk a tightrope between the two.”