MACRA's Effect on Physician Reimbursement an Uncertainty

Physicians are uncertain if Medicare’s Quality Payment Program (QPP), more commonly known referred to by the acronym of the law which passed it into existence - the Medicare and CHIP Reauthorization Act (MACRA) - is going to affect their compensation.According to the Physicians Practice Compensation Survey, 61.8 percent of physician respondents are unsure how MACRA will have an effect on their overall reimbursement in 2019, based on data submitted to CMS this year. This is compared to 13.8 percent who expect their Medicare reimbursement will be higher because of MACRA and 24.4 percent who expect it to be lower.The Physicians Practice Compensation Survey was taken by 618 physicians across multiple specialties, regions and employment models. Part 1 of the survey results were posted here.The uncertainty with MACRA doesn't just end with the effect on physician reimbursement. Many physician respondents (43.8 percent) are unsure if they will be able to receive exemption status for the 2018 performance year. CMS recently finalized the exemption floor for participation in the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs) at less than or equal to $90,000 in Medicare Part B allowed charges or less than or equal to 200 Part B beneficiaries. Only 8.8 percent of physicians say they will receive exemption status, while 47.4 percent will not receive it.Other highlights from this year's compensation survey include:
• Nearly half of the physicians are seeing more Medicaid patients due to eligibility expansion; 35.2 percent said they are not seeing more Medicaid patients and 16.1 live in states that have refused to expand. A whopping 83.6 percent are accepting patients who purchase plans through insurance exchanges.
• Most physicians (57.3 percent) say the uncertainty surrounding the ACA has not had an effect on the number of patients they've seen with insurance exchange plans.
• High-deductible health plans are having a negative effect on 49.2 percent of physician respondents, who say they're having a harder time with patient collections. (For helpful strategies, read 9 Tips to Improve Patient Collections.)
• In order to boost revenue, 36 percent of responding physicians are increasing the number of patients they see per day; 27.5 percent have done more marketing; and 24 percent are doing more ancillary services.