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MACRA Fallout and Physician Burnout – MACRA Monday

Posted on October 24, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

I’ve been traveling the past week and still haven’t had time to fully process the MACRA final rule. In fact, it might take me a few weeks to really get things together around what’s in the final rule. It’s better that I take my time and make sure I provide you accurate information than to post early and perpetuate bad information. So, I appreciate your patience.

In the mean time, we’ll still continue on with MACRA Monday talking about some of the impact of the MACRA rule and interesting comments on what’s happening with MACRA. Today I wanted to highlight the vitriol I’ve seen online by many physicians towards MACRA. It’s been pretty ugly.

If I’m being fair to MACRA, most of the hatred has to do with the wave of government regulations and the changes happening across all of healthcare and not just MACRA. In many cases, it just seems that MACRA is the straw that broke the proverbial camel’s back. However, I’ve seen first-hand from more physicians than I can count, a real anger towards MACRA.

I do temper these experiences with the fact that so many physicians barely even know that MACRA exits. That’s not true for the ones complaining on social media, but it definitely feels like even many of those doctors barely realize what is in MACRA (with a few notable exceptions). Instead of specific complaints, they are mostly general complaints about government regulation.

Sadly, I think it kind of reminds me of my experience talking with my 12-year-old son. He’s at the stage of life where no matter what I say as a father he wants to say the opposite. I can literally say something nice to him like “You’re smart” and without even thinking about what I said he’ll knee jerk react “No, I’m not.” It makes no sense and is absolutely frustrating as a parent.

My guess is this is how the people at CMS feel when they hear doctors talking about MACRA. If MACRA was just free government money with no work, my gut is that many doctors would say it’s awful without even looking at the details. Doctors are so burnt out on government regulation that they denounce it without as much as a second thought.

Given some of the past track record, doctors have good reason to react the way they do. Can you point to very many places where meaningful use made a doctor’s life better? There are quite a few general EHR benefits, but very few specific meaningful use benefits. In fact, you can make a strong case that meaningful use added a lot of overhead and almost no value to patients or doctors. Given that, should we be surprised that doctors are afraid of more government regulation?

I’m not surprised, but with that said I also don’t think that MACRA will be the disaster that many make it out to be. In fact, I think it’s an extension of business as usual. This is particularly true in the first year of MACRA where almost no one will get penalized thanks to the MACRA Pick Your Pace options. We’ll see if that creates a pileup in future years.

I’m torn since I think we’re entering one of the most exciting times to be in healthcare. The technologies that are hitting healthcare are quite extraordinary. What we’ll be able to do with the data we’re collecting and will be able to collect in healthcare is going to surprise us all. However, on the other hand regulations are creating a burden on providers that is causing what could be irreparable harm.

Reminds me of that famous line, “It was the best of times, it was the worst of times.”

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

New Eligibility Exclusions in the MACRA Final Rule – MACRA Monday

Posted on October 17, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Last week on Friday, we posted the various resources available for the MACRA Final Rule. As you can imagine, one weekend isn’t nearly enough time to process what’s in the final rule. It’s going to take weeks to really get through it all. In fact, we might take a few weeks off from MACRA Monday to process it all.

That said, we wanted to do a quick post this MACRA Monday to talk about the new eligibility requirements and thresholds in the MACRA final rule. For reference, here’s our previous post that looked at MIPS eligibility in the MACRA proposed rule.

In the final rule, it looks like there are still 3 categories of exceptions: new doctors, low medicare volume and participation in an advanced APM. The big change in the MACRA final rule is what is considered low medicare volume. In the proposed rule it said, “$10,000 and providers care to 100 or fewer Medicare patients in a year.” Note the “and” in that requirement. In the MACRA final rule it excludes doctors with less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients.” Note the “or” and the move from $10k in Medicare volume to $30k in Medicare volume.

With these three exceptions, Andy Slavitt sent the following tweet:

I quickly commented, “Now you’re going to get the small practices complaining that they were excluded from the incentives. #MACRA #CantWin” CMS’s MACRA executive summary says that they considered allowing those that were below these levels to opt into MIPS if they desired, but they “determined that it was inconsistent with the statutory MIPS exclusion based on the low-volume threshold.” I think the complaining for not being allowed to participate will be pretty minimal. 4% of such a small volume of Medicare won’t be that impactful for most.

There’s the start of our analysis of the MACRA final rule. A good first step to knowing if you qualify to participate in MACRA. Let us know if there are changes in the final rule that you’ve noted or that are bothering you. We’d love to hear them in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.