MACRA: What is this Federal Payment Reform? Many Don’t Know

Nearly nine in 10 respondents to a Medscape survey said that they either have not heard of, don’t know a lot about, or know a little bit about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Not knowing what MACRA is at this point is troubling – perhaps the federal government needs to do a better job on its public relations campaign for the program – while it’s much less surprising that most US physicians don’t know much about the rule. It’s a complicated nearly 2,200-page piece of legislation. 

The survey, delivered online throughout September 2016, only included responses from the 282 physicians, so it’s likely not statistically sound as much as it is informative. Each of the respective respondents saw 20 or more patients per month. The MACRA final rule was published by the Department of Health & Human Services (HHS) on October 14. Of those, about 88 percent of respondents said they are very unfamiliar with the new law that will change how eligible Medicare physicians will be reimbursed, starting with an outcomes-based Quality Payment Program set to kick off in 2017.

Only 2.1 percent of respondents said they knew a lot about MACRA; 28.6 percent said they have not heard of MACRA and 39.2 percent said they have but don't know a lot about it.

According to Healthcare Dive, the Medscape survey mirrors Deloitte’s 2016 Survey of U.S. physicians released in July 2016 that suggested that only about 50 percent of practicing physicians had heard of MACRA at that time. The Deloitte survey at the time used responses from 600 physicians, so it was far more of a representative sample than that of Medscape.

The reason for the lack of awareness, Medscape supposes, is that MACRA is simply one more stone atop the pile of the rocks stacked at the threshold of healthcare, including payment reform, certification, health IT technology, etc. For example, one physician response said: “I can't keep up with all the changes in payment, board certification, keeping computer systems working, and oh yeah, taking care of patients!” 

According to federal officials, MACRA aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (Advanced APMs).

About half (51 percent) of those surveyed said they are already report Physician Quality Reporting System to the Centers for Medicare & Medicaid Services (CMS), and of those who do report, most of them (63.5 percent) report via an electronic health record, qualified registry. The MedScape survey points out that of those people who don’t report, most don’t report because they don’t know how (34 percent).

Healthcare Informatics reports that other concerns about MACRA include: lack of knowledge about how to participate; will it detract from the “humanity” of medicine; will it require more paperwork time at the expense of patient time; and will it penalize physicians for things that are out of their control.

For a comprehensive question and answer about MACRA and Medicare payment reform, visit the American Academy of Family Physicians.  

Scott Rupp's picture

Scott Rupp

Contributor

Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.

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