Medicare’s impact on independent practices

Medicare’s impact on independent practices

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its associated Merit-based Incentive Payment System (MIPS) have proved quite challenging to many independent practices. In addition, the Medicare-qualifying patient population is expected to increase from 55 million to 80 million by 2030. How does all of this impact independent practices?

A recent BlackBook Research survey of 1300 very small independent practices found that “67% of such physician practices believe their independence will end with MACRA.” In addition, 89% of the solo practices that participated in the survey “plan to minimize Medicare volume to avoid filing quality and clinical practice improvement reports or cost performance reports to CMS.”

There is much confusion among independent physician practices as well. Of the very small practices surveyed, “63% remain unsure which health information technology and products meet their needs for meaningful use, clinician usability, interoperability and coordinated claims and billing.”

Fortunately for these independent practices, the Centers for Medicare & Medicaid Services (CMS) has released a new proposed rule for 2018 that would simplify requirements going forward. Recognizing that small practices may not have the resources needed to comply, CMS has increased the thresholds for required participation in MIPS in the proposed rule. The new proposal increases the threshold from $30,000 or less in Medicare Part B allowed charges or less than 100 Medicare patients to $90,000 in Part B allowed charges or less than 200 Medicare patients.

Other proposed changes for 2018 include allowing the use of the 2014 Edition CEHRT (Certified Electronic Health Record Technology) and adding bonus points in the scoring methodology for caring for complex patients and for using 2015 Edition CEHRT exclusively.

Moving from a fee-for-service structure to a value-based payment plan is an important strategy for independent physicians who are primarily focused on their patients’ healthcare outcomes. However, the future of these independent practices as it relates to their willingness and ability to continue in the Medicare program may depend on the outcome of the proposed 2018 rule.