Starting in 2019, the Quality Payment program (QPP), which was put into place by the Medicare Access and CHIP authorization ACT (MACRA) of 2015, will begging to adjust payments to physicians. The Merit-based Incentive payment system or MIPS is one option and calls for reporting some quality measures and EMR use. The other option the Advanced Alternative Payment Model (APM) will consist of a 5% lump sum payment (and exclusion from MIPS) if a physician has a certain portion of their revenue or patients in APM. This was in place of repeal of the SGR or Sustainable Growth rate
A KPG/AMA survey of 1000 practicing physicians showed that 51% of physicians were somewhat aware if MACRA/MIPS and 70% were preparing to meet QPP requirements in 2017. Only 8% feel ‘very prepared’ for long-term success. There was no difference between primary care or specialist physicians.
56% expect to participate in MIPS in 2017 and 2% expect to meet APM standards. However, of those participating in MIPS 90% felt that these requirements were burdensome with the time requirement representing the most challenge. Multi-specialty practices were more knowledgeable about issues. The most difficult questions to understand were: how the quality basis was going to be measured and reported and which practice improvements were going to be acceptable.
As far as lower fee-for-service payments from Medicare in 2017, about 500,000 clinicians (half physicians) are anticipated to lose about 2% in payments because Physician Quality Reporting System (PQRS) in 2015.( http://www.medscape.com/viewarticle/881870)
An interesting take on MACRA and increasing physician employment by hospitals comes from FITCH, the bond rating agency. "MACRA could provide the nudge needed for markets with less physician employment and integration to consolidate and integrate physicians, disrupting long standing referral patterns and increasing costs as these markets sort themselves out," according to Fitch Ratings. (http://www.beckershospitalreview.com/hospital-physician-relationships/fitch-macra-encourages-hospital-employment-of-physicians.html) A FITCH director also says “"Employing physicians, when executed well, can help solidify a hospital's market position and grow its clinical footprint - offsetting their associated expenses."
Comment: The operative phrase here is ‘when executed well!” We all know that part is rare.