News | Cardiovascular Business | July 07, 2016

Survey Shows Small Practices Wary of MACRA Effects

Two-thirds of independent practices are deliberating selling out to hospital systems and larger groups or closing down by 2019 in the face of transitioning to value-based care

MACRA, Black Book survey, independent physician practices, effects

July 7, 2016 — According to a May 2016 survey of 1,300 physician groups of five or less clinicians, 67 percent of high Medicare-volume doctors foresee the end of their independence due to the Medicare Access & CHIP Reauthorization Act (MACRA). The bill repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new value-based reimbursement system.

Despite small practice education, training and technical assistance programs promised from the Centers for Medicare and Medicaid Services (CMS) to help onboard physicians with the MACRA programs, 89 percent of the remaining solo practices expect to minimize Medicare volumes as to not be required to submit reports for the quality and clinical practice improvement activities or report in the cost performance category.

Seventy-seven percent of small practices identified themselves as financially struggling currently due to physician staffing losses to larger group practices and hospital integrated delivery networks (IDNs) directly. Seventy-two percent also blame their under-performing billing technology and compounding payment issues for their troubles.

 “Physician payment based on 2017 performance isn't scheduled to kick in until 2019,” said Doug Brown, managing partner of Black Book, the market research firm that conducted the survey. “That's far too long to maintain operations for the most stressed practices to hold on with outmoded technology and scarce billing support.”

The apparent solution for 78 percent of remaining independent primary care physicians is to join a bigger group or IDN to gain needed reporting, revenue cycle tools and support before 2019.

Black Book anticipates the electronic health record (EHR) replacement market to decline in the small practice market as 55 percent of independent practitioners indicate they will make no technology shifts or purchases until they have made decisions on being acquired. “On the other hand, the growth opportunities for EHR vendors currently serving the larger practice market, IDNs and multi-specialty clinics are expected to appreciably benefit from these small practice acquisitions,” said Brown.

Based on the aggregate client experience and customer satisfaction scores on 18 key performance indicators tuned to physician practice integration of documentation, operations and revenue cycle management, the top-ranked EHRs for small practices have changed as more cloud-based EHRs have made competitive pricing among several demands, particularly integrated billing, specialist-driven focuses, mobility, interoperability and patient satisfaction support.

Sixty-three percent of smaller (fewer than ten practitioners) and solo practice physicians have still not settled on a technology suite or set of products that delivers to their expectations on Meaningful Use, clinician usability, interoperability and coordinated billing and claims. But, over a third of those slower adopters expect to make product decisions before the end of this calendar year.

The top ranked solo/single physician practice EHRs in the 2016 survey are Kareo, Modernizing Medicine, drChrono, iPatientCare, athenahealth, CareCloud and Practice Fusion.

The top ranked EHRs for practices of two to five physicians are SRS Soft, ADP AdvancedMD, Practice Fusion, Amazing Charts and Allscripts.

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