Top risks for doctors under MACRA

Loss of autonomy

Central to the transformation of value-based care is implementation of evidence-informed clinical decision support to reduce inappropriate testing and treatment. However, implementation and “enforcement” of protocol-based care that limits physician flexibility or penalizea noncompliance can potentially suppress physician critical thinking and problem-solving. Deviation from protocols should be expected based on individual circumstances and physician judgement. Standardized care shouldn’t be a straitjacket.

Burdensome documentation

Under reform, Meaningful Use (MU) morphs into “Advancing Care Information” (ACI). Current rules for MU are widely viewed as requiring documentation of clinically irrelevant information rather than real patient-focused outcomes.

Currently, reporting quality metrics is estimated to cost physician practices $15 billion annually with individual physicians devoting almost 800 hours annually to this task.  It’s no surprise that EHRs are a source of physician frustration. Will ACI cut the clicks? It’s unclear.

More stress

A recent Mayo Clinic study reported 54% of physicians were experiencing at least one symptom of  burnout. Burnout includes loss of enthusiasm for work, increased feelings of cynicism and a feeling of being more callous with coworkers. Beyond purely personal concerns, burnout clearly has implications for the healthcare system with premature physician retirement and reduced access to medical care. 

Burnout is a consequence of increased non-clinical paperwork, dissatisfaction with EHRs, loss of autonomy and less time for family. Physicians are concerned reform will add to already burdensome reporting requirements.

Solo and small practices pressured

There will be winners and losers with adjustment of reimbursements for services based on a complex Merit-based Incentive Payment System (MIPS) that ranks physician performance according to four weighted metrics. Winners receive reimbursement incentives of 4% to 9% with a corresponding negative hit for losers.

Many solo physicians and smaller group practices are concerned they will get the short end of the stick, as they are less likely to have the costly robust data reporting capability of the larger groups. CMS projects 87% of solo practices will face negative adjustments of reimbursement in 2019.