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I’ve had it with acronyms. 

SGR [Sustainable Growth Rate] was replaced by MACRA [Medicare Access and CHIP Reauthorization Act] which allows physicians to choose between two Medicare payment programs: (a) MIPS [Merit-Based Incentive Payment System; and (b) APMs [Alternative Payment Models].  

According to CMS [Center for Medicare and Medicaid Services], these changes create a QPP [Quality Payment Program].  

According to CMS, MIPS is a new program that combines parts of PQRS [Physician Quality Reporting System], the VM [Value Modifier]; and the HER [Medicare Electronic Health Record incentive program] into a single program in which EPs [Eligible Professionals] will be measured on:

  • Quality 
  • Resource Use 
  • Clinical Practice Improvement 
  • Meaningful Use of HER Technology 

Since Medicare believes most physicians who participate will opt for MIPS, I won’t dwell on APMs.  

I sat in on a lecture about prospering with MACRA. I wanted to learn more. In the auditorium I saw a few physicians. While I believe the program is well-intentioned (who would be against quality or value; it’s like Mom and Apple Pie – everyone is for it), I’m skeptical the programs will deliver value or quality.  

I was not able to understand the programs. 

If incentives are not clear, concise, and well-defined, how can any participant know how to hit their marks? 

While a few physicians attended, I mostly saw health system bureaucrats. They were there to learn the game. Yes, it’s a game. And played properly, I’m sure it can be profitable.  

These are the same bureaucrats who created what is euphemistically known as a “facility fee.” If you see a newly employed primary care doctor – or specialist, you pay a professional fee (no surprise there). Often you also pay a facility fee. That’s the surcharge the institution places for using its building. Interestingly, my accountant does not charge a facility fee. My lawyer does not charge a facility fee. Doctors in private practice don’t charge a facility fee. Only hotels charge a facility fee, because the service you receive is actual access to its facility.  

My conclusion. Large practices will participate in MACRA. Many in small or solo practices will opt out of Medicare and its acronyms.  

That does not imply small or solo practices will become extinct. On the contrary.  

I recently had lunch with a talented primary care doctor. He was previously an employee in a large healthcare system. He was tired of the rat race. He hung out a shingle with his wife, another primary care doctor. They are launching a DPC [Direct Primary Care] practice. This is one acronym worth investigating. They charge patients a modest subscription fee for essentially unlimited primary care. No waits. Patients have the doctor’s cell phone number. Labs in the office are priced at wholesale rates.  

Transitioning to a DPC model can be scary. Why? The doctor opts out of third party reimbursement. But, one’s overhead plummets. Regulatory burdens decrease. Time available to spend with patients go up.  

My only counsel to the DPC physician was to make sure he had enough of a financial runway to see the project through. I believe he and his wife will succeed. Others will likely follow. If MACRA turns out to be the stimulus for such innovation, I’m glad it passed.  

What do you think? Share your comments below.


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