CMS must stop manipulating small practices

The federal government must rethink its strategy of working to put small medical practices out of business.

The federal government must rethink its strategy of working to put small medical practices out of business.

First, it required small offices to invest in electronic health records (EHRs) and participate in the gauntlet that is Meaningful Use or face penalties. Most physicians complied and, to this day, continue to struggle in the digital era of patient care. Others said, “Go ahead and dock my pay.”


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Next, the Affordable Care Act promised greater care for more Americans, but gave little support to already overburdened doctors. Our readers recently gave Obamacare a resounding “F” grade. They continue to stick it out-caught in the middle between patients and payers on a daily basis-and remain dedicated to improving the well-being of those in their care.

And now, on the horizon looms the Quality Payment Program and all of its alphabet soup: MACRA, MIPS and APMs. No matter what you call it, at least this time, the Centers for Medicare & Medicaid Services (CMS) actually recognized that small practices were going to be in trouble, estimating losses in the range of $600 million for practices with one to nine physicians. They later backtracked, citing old data and yet-to-be-solidified accommodations planned for these practices.  

CMS did announce $100 million over 5 years in “technical assistance” to help practices with 15 or fewer clinicians succeed under its Quality Payment Program.  The problem is that $20 million a year for the hundreds of thousands of docs with Medicare patients who qualify for help means CMS can offer an average of $80 in help per practice.  Perhaps that’s enough to buy “Medicare Payment Reform for Dummies” and ear plugs to block out the screams of peers and staff.

Next: Will CMS come to its senses?


Now there’s been strong indicators that the wise folks at CMS will make further concessions to physicians and perhaps even delay metric reporting from the currently proposed target date of Jan. 1, 2017-less than four months away.

There are things CMS can do to level the field for smaller practices. Former federal regulator Farzad Mostashari, MD, outlined them in our last issue: compare small practices to their peers in terms of size, promote payment models limiting loss, and get out of the business of using single-year data for larger timeframes. Seems simple, right?


Further reading: MIPS-4 categories physicians must master


But the question remains: Will CMS come to its senses and realize that driving small practices into joining the local hospital or health system is failing and that small practices are stronger than they thought? Or will they realize that picking on the smaller kid on the playground repeatedly doesn’t make the little guy weaker, it strengthens him and fuels the fight within even more?

My money’s on the little guy. 



Keith L. Martin is content channel director for Medical Economics. Can small practices survive the latest threat in the form of MACRA? Tell us at

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