Quietly, last year, President Obama signed a bill into law that could greatly affect Medicare patients. Called the Medicare Access and Chips Reauthorization Act (MACRA), it will substantially change how doctors and clinicians are paid for treating Medicare patients.
This innocuous sounding law will move payments from a fee-for-service system, to one based on the "quality" of services performed. Doctors exceeding their peers in the "quality" of care given, will receive bonuses. Doctors who fail to meet the average score of their peers will receive, initially, a 4% penalty on the billings being submitted. This is already below the average of 11% that Medicare underpays doctors. In other words, our government will start picking winners and losers among our base of doctors; and hopefully yours won't be on the losing side. Using a 100 score potential, anyone scoring 49 will be the penalized, although this does not mean that half the docs will be dinged on their billing. For example, if 75% score 50 or better, only 25% will be penalized. Doctors who bill less than $10,000 and have fewer than 100 Medicare patients are exempt from the program.
The biggest problem with the system is that a computer will take all the scoring data being submitted by doctors in 2017, and apply an applicable bonus or penalty starting in 2019. And, in typical government fashion, the doctors won't get their quality score until they submit their billing. Of course, there's no recourse for contending their status.
When I learned of MACRA's nearly 2500 pages of final rulings submitted by Health and Human Services, it was a day before I had a doctor's appointment. From what I read about the law, a number of doctors may stop taking Medicare patients; especially those slightly above the $10,000/100 patient threshold. God help you if your doctor has, say, 105 patients. You just may be one of the 6 unlucky patients that he/she may stop seeing to avoid the law altogether.
So, when I saw my doctor the next day, I asked him if he will continue to take Medicare patients when MACRA kicks in and, to my relief, his response was "yes". However, that was short lived when he continued on to say that any Medicare patients may be changed to a cash only basis because that is one of the options that he and his partners are looking at in order to avoid the onerous penalties and paperwork that they would be subjected too with MACRA.
I could go into all the problems with MACRA that could ultimately result as doctors, either stop treating Medicare patients, or just retire early; but, that is best explained in the link referenced below. As of 2014, a Merritt Hawkings survey found that only 76% of the doctors surveyed took Medicare patients. Will this law make it less than 50% or, even, 40%? Needless to say, MACRA, like ObamaCare, is another government intervention that won't work and will probably need to be repealed before too much damage is done.
Physician payment in Medicare is changing: Three highlights in the MACRA proposed rule that providers need to know: https://www.brookings.edu/blog/health360/2016/05/04/physician-payment-in-medicare-is-changing-three-highlights-in-the-macra-proposed-rule-that-providers-need-to-know/
MACRA Proposed Rule Creates More Problems Than It Solves: http://healthaffairs.org/blog/2016/10/12/macra-proposed-rule-creates-more-problems-than-it-solves/
How Physicians Can Prepare for the Financial Impact of MACRA: https://www.healthcatalyst.com/physicians-must-prep-for-the-financial-impact-of-macra
50% of physicians have never heard of MACRA, Deloitte finds: http://www.beckershospitalreview.com/finance/50-of-physicians-have-never-heard-of-macra-deloitte-finds.html
Beleaguered by electronic record mandates, some doctors burning out: http://www.chicagotribune.com/business/ct-doctors-hate-records-mandate-1213-biz-20151211-story.html
Medicare vs. private insurance: Which costs less: http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/
American Hospital Association: Payment Facts: http://www.aha.org/research/policy/finfactsheets.shtml
How MACRA will decimate the private practice physician: http://www.kevinmd.com/blog/2016/07/macra-will-decimate-private-practice-physician.html
The Mess That is MACRA: http://www.pnhp.org/news/2016/april/the-mess-that-is-macra
Risk of ‘Mass Exodus’ of Doctors from Medicare: http://www.lifezette.com/polizette/risk-of-mass-exodus-of-doctors-from-medicare/
With MACRA looming, doctors can't afford waiting to plumb its intricacies: http://www.modernhealthcare.com/article/20160723/MAGAZINE/307239981
Physician Frustration and Fear of MACRA: http://catalyst.nejm.org/physician-frustration-fear-macra/
Merritt Hawkins Medicare Medicaid Acceptance and Wait Times: http://www.merritthawkins.com/uploadedfiles/merritthawkings/surveys/mha2014waitsurvpdf.pdf
The MACRA rule: Not what Congress ordered: http://www.kevinmd.com/blog/2016/06/macra-rule-not-congress-ordered.html