The Docs Have Already Tuned Out on MACRA

Welcometo the first edition of Editor's Corner. Here, the editors of Physicians Practice will share their thoughts on the happenings in healthcare and look at the industry from a broader viewpoint.

The longest book I've ever read was 1,120 pages. It was also the best book I've ever read.

"Truman" by David McCullough is as captivating as it gets. It's no surprise that it won a Pulitzer Prize. The story of the 33^rd President of the United States doesn't ever feel like you are slogging through 1,120 pages. Rather, it takes you with ease through each phase of Truman's life as he goes from a simple Missouri farmer to the highest office in the country. It's like reading a folk tale, except we know that it actually happened.

I cannot recommend it enough. Even if you think you could never get through a 1,120 page book, I bet you could if you were reading "Truman."

Why, you may be asking yourself, am I bringing up "Truman" in a blog on healthcare? It's simple. I wanted you to know it is possible for someone to create a document that is about 1,000 pages long and have it be interesting, forthright, and inspiring.

The same cannot be said when about the 962-page proposed rule for implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) from CMS.

Of course, no one ever would expect a proposed rule written by government lawyers to be as interesting, forthright, or inspiring as one of the great books in American history. But here's the thing: In order to get doctors on board with the changes proposed in MACRA, the 962-page proposed rule needed to have been as interesting as "Truman." If not, it should have been a lot shorter and a lot less convoluted.

That's the truth. After years of elaborate, headache-inducing rules from CMS on Meaningful Use and other reporting programs, most doctors don't have the time of day to read through another one. They needed to be wowed. Instead, they were given more elaborate rules and headaches.

Yes, there are positive aspects of the MACRA rule. It is more flexible than Meaningful Use, the Physician Quality Reporting System (PQRS), and the Value Modifier Program. It takes away the all or nothing approach from Meaningful Use, it reduces the quality measures required under PQRS from nine to six under MACRA, and it attempts to align the programs with each other as well as what's being offered by private payers.

Moreover, I think it is noble - not to mention perpetually difficult - in trying to shift the healthcare system from one that compensates based on volume to one that pays for value. Any effort is worth trying to accomplish, especially one that is trying to fix the problems of past mandates.

Yet, any accommodations made in MACRA to curb previous efforts are too little, too late. The physicians have already tuned out the government, thanks to Meaningful Use, PQRS, and the other reporting mandates they faced over the past few years. CMS needed to come out with something that would forcibly grab physicians' attention and get them on board. Instead it got a 962-page rule that, as one masterful healthcare expert said, is "…so overwhelmingly complex, that no mere human will be able to understand them."

What's worse for physicians is that they don't have a lot of time to get ready for MACRA year one under the proposed rule. Reporting starts on Jan. 1, 2017. Considering the final rule will not be released until this fall, they are working with a short window to digest something that an expert has described as overwhelmingly complex. That's not a good sign.

After the proposed rule was released, I asked a few experts if CMS could do anything to win back the "hearts and minds" of physicians, which seems to be their goal based on what's been said by the agency's Acting Administrator, Andy Slavitt. Many told me that it didn't matter whether or not physicians would buy in because MACRA was their future, like it or not.

I don't agree. I believe that many independent, small practice physicians will see the mandates from MACRA as another sign that they need to abandon ship. They'll become employed, go with direct-pay or concierge care, or leave medicine altogether, if they haven't already.

Follow Gabriel Perna on Twitter at @GabrielSPerna