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How Will MACRA Legislation Affect Small Physician Practices?

Some small physician practices could struggle with the impending MACRA implementation, and their concerns are palpable, a survey finds.

By Sara Heath

Small independent practices are wary of MACRA, and fear that they may not survive the new legislation, according to a recent Black Book survey.

The survey, which was conducted in May 2016 with 1,300 physicians, shows that small physician practices may not have the resources to be successful under the Medicare Access and CHIP Reauthorization Act, the details of which were released at the end of April.

The proposed MACRA implementation includes several educational services from the Centers for Medicare and Medicaid Services (CMS), as well as opportunities to assist small physician practices in the transition.

Despite those services, the Black Book survey found that 89 percent of physician practices plan to reduce the number of Medicare cases they take on in order to reduce the reporting burden.

Small physician practices reported concerns about having adequate staffing in order to accomplish necessary reporting for MACRA, and also stated that they are currently struggling under already-existing policies.

Over three quarters of these practices stated that they are having staffing issues because many of their employees have begun jobs at other larger practices, and 72 percent say their billing processing systems serve as a major hurdle in financial status.

“Physician payment based on 2017 performance isn't scheduled to kick in until 2019,” said Doug Brown, managing partner for Black Book in a press release. “That's far too long to maintain operations for the most stressed practices to hold on with outmoded technology and scarce billing support.”

Many are turning toward larger practices for reprieve. Seventy-eight percent of respondents say they are considering joining a bigger group of IDN (integrated delivery network) in light of the MACRA legislation. Doing so may help with reporting, revenue cycle tools, and other supports prior to 2019.

Black Book also notes that EHR adoption rates may slow in light of these trends. Because small physician practices are considering transitioning to a larger group, many state they will put any EHR-related projects on hold until they have decided their path forward.

That does not mean the EHR industry will struggle overall, however. Because smaller practices may merge with larger ones, EHR vendors are likely to see new projects emerge at large hospitals and practices to accommodate the new physicians.

“On the other hand, the growth opportunities for EHR vendors currently serving the larger practice market, IDNs and multi-specialty clinics are expected to appreciably benefit from these small practice acquisitions,” Brown said.

EHR needs among smaller practices include integrated billing, specialist-driven focuses, mobility, interoperability, and patient satisfaction support.

The survey also shows the state of slower EHR adopters and where they are in their processes. Nearly two thirds have not found a technology suite which suits their revenue cycle, clinician usability, interoperability, and coordination billing and claims needs. However, more than a third report that they expect to make a decision by the end of this calendar year.

Recently, CMS has posted new efforts to help healthcare providers transition to MACRA. Just last week, the agency announced $10 million in grant funding to implement programs helping hospitals and provider groups transition to the new system.

The $10 million will help fund the second round of the Support and Alignment Networks (SANs) under the Transforming Clinical Practice Initiative (TCPI).

"Through this initiative, the Support and Alignment Network 2.0 awardees will identify, enroll, and provide tailored technical assistance to advanced clinician practices in an effort to reduce Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) program expenditures by supporting practices through the phases of transformation and enhancing the quality, efficiency, and coordination of care they deliver," the federal agency said in a press release.

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