Dctor FishingFor Cash

How Doctors Get Paid Is Changing

MACRA is here. The Medicare Access and CHIP Reauthorization ACT of 2015, or MACRA, represents an ideological shift in healthcare that garnered tremendous bipartisan support in both the House and Senate. MACRA repeals the failing Sustainable Growth Rate (SGR) and shifts Medicare reimbursements to a new value-based model.

What does that mean? Now, Medicare reimbursement is based on the quality of care a patient receives, not the number of encounters. It's an entirely new way of measuring and thinking about healthcare.

MACRA aims to:

  • Stop the growing cost of healthcare
  • Address budget deficits
  • Increase the quality of healthcare

Despite MACRA’s ambitious vision, some argue that MACRA actually punishes physicians especially those in small practices. Regardless of its future success, one thing is certain: many U.S. physicians feel caught in the middle. Forced to take on a large-scale transition by implementing MACRA on their own.

What We Did

We surveyed the healthcare industry about their feelings toward MACRA from April 2017 to June 2017. Here’s a closer look at who took the survey:

1052 HealthCare Professionals Responded

1-3 Provider Practices - 63%, 4-10 Providers - 16%, 11+ Providers - 14%, Other - 6%. Total Responses 992

MACRA is expected to affect small practices the most, so we’re thrilled to have received such a strong response. We consider small practices to have 1-3 providers, so when we say small - we mean small. In our findings section, we’ll compare how small and large practices feel about MACRA.

Do You Own Your Practice or Business? 42%(415) Yes, 58%(577) No, 9%(90) - Total Responses:992

We’ve established that the majority of survey takers work in small practices, so it follows that almost half are also business owners. When it comes to MACRA, the opinions of small practices owners matter the most.

Top 5 Specialty Responses: Mental Health - 18% (168) Internal Medicine - 15% (144) Family Practice - 12% (119) Physical Therapy - 4% (38) General Practice - 3% (34)

We know that specialty is everything, so we wanted to highlight our largest specialty responses. We’ve even included a special Mental Health analysis of our survey to show our appreciation.

Top 5 Specialty Responses: Mental Health - 18% (168) Internal Medicine - 15% (144) Family Practice - 12% (119) Physical Therapy - 4% (38) General Practice - 3% (34)

Most importantly, almost half of our respondents are patient care professionals. When it comes to small practices, these are the shoulders that MACRA will burden the most. We’re thrilled to share how they feel about it.

Demographic Raw Data

Practice Ownership
  • Owner: 42% (415)
  • Not Owner: 58% (577)
Practice Size
  • 1-3 provider: 63% (629)
  • 4-10 provider: 16% (162)
  • 11+ provider: 14% (140)
  • Other: 6% (61)
Practice Role
  • Patient Care: 48% (471)
  • Office Manager: 17% (172)
  • Administrators: 15% (144)
  • Biller: 10% (98)
  • Office Staff: 6% (62)
  • Other: 4% (42)
Specialties

  • Mental Health: 18% (186)
  • Family Practice: 12% (119)
  • Internal Medicine: 7% (69)
  • Physical Therapy: 3.8% (38)
  • General Practice: 3.4% (34)
  • Podiatry: 3.1% (31)
  • Pediatric Medicine: 2.9% (29)
  • Obstetrics/Gynecology: 2.5% (25)
  • Chiropractic: 2.4% (24)
  • Surgery: 2.3% (23)
  • Billing Company: 1.9% (19)
  • Addiction Medicine: 1.8% (18)
  • Pain Medicine: 1.7% (17)
  • Nurse Practitioner: 1.6% (16)
  • Orthopedics: 1.6% (16)
  • Radiology: 1.5% (15)
  • Ophthalmology: 1.5% (15)
  • Geriatric Medicine: 1.4% (14)
  • Gastroenterology: 1.4% (14)
  • Dermatology: 1.3% (13)
  • Optometry: 1.3% (13)
  • Cardiology: 1.2% (12)
  • Pulmonology: 1% (10)
  • Child and Family Services: 1% (10)
  • Infectious Disease: .9% (9)
  • Clinical Lab: .8% (8)
  • Neurology: .8% (8)
  • Emergency Medicine: .8% (8)
  • Anesthesiology: .8% (8)
  • Clinical Social Work: .8% (8)
  • Neuropsychology: .7% (7)
  • Allergy: .7% (7)
  • Occupational Therapy: .7% (7)
  • Oncology: .7% (7)
  • Nephrology: .7% (7)
  • Speech Pathology: .6% (6)
  • Sleep Medicine: .5% (5)
  • Neurosurgery: .4% (4)
  • Vascular Surgery: .4% (4)
  • Dental General Practice: .4% (4)
  • Rheumatology: .4% (4)
  • Otolaryngology: .3% (3)
  • Critical Care: .3% (3)
  • Audiology: .3% (3)
  • Plastic/Recon Surgery: .3% (3)
  • Urology : .2% (2)
  • Edocrinology : .2% (2)
  • Osteopathic: .1% (1)
  • Preventative Medicine: .1% (1)
  • Hematology: .1% (1)
  • Other: 4.1% (41)

Why We Did It

In 2017, MACRA hit the ground running. While CMS works frantically to ensure a smooth transition, it seems that healthcare professionals are closing their eyes and hoping someone slams on the brakes.

Several recent surveys have documented the industry’s sobering lack of technological preparedness and resources. However, we wanted to take a step back and get a sense of how healthcare professionals are feeling. We took the industry’s temperature to see what healthcare professionals really think about MACRA.

Playing Catch-Up
Most provider organizations without a MACRA plan expect to purchase software or outsource last minute in 2017. Source: Black Book Survey


Where To Begin

MACRA is no joke. It’s a dense subject, even for those very familiar with it. We like to keep things simple, so we’ve boiled our analysis down to the bare bones.

If you’re totally new to MACRA. Here’s some resources to help you get started: