This article is more than 5 years old. Information may no longer be current.
As an orthopedist in a small practice, do you feel prepared for and educated on MACRA? Why or why not?
Click Here to Manage Email Alerts
Click here to read the Cover Story, “Small orthopedic practices aim to succeed with implementation of MACRA.”
Lack of resources, tools
As an orthopedic surgeon in a small, private practice, I feel poorly prepared and poorly educated with regard to MACRA. A quick online search allows one to review the general concepts and various professional publications. Most notably, Orthopedics Today does a great job of bringing readers up to speed. However, the bottom line is that the rules are arcane (understood by few and somewhat mysterious) and implementation will inevitably be time consuming and costly. For example, our practice recently learned that our current, costly, time-consuming EMR software is not designed for MACRA, and as a result, our practice must incur time and expense to “upgrade” in order to comply.
There is no doubt that the physician SGR formula required repeal. Furthermore, it seems both reasonable and advantageous that physician compensation be tied to quality and cost effectiveness, so long as there is consideration and adjustment for patient medical comorbidity and socioeconomic disadvantage, as these factors are inversely correlated with positive outcomes. Likewise, in theory, implementation of an EMR could be of great benefit to public health and could be universal health coverage. Unfortunately, in practice, our government and the CMS seem to put the proverbial cart before the horse and bring about rules and regulations, while failing to provide health care providers with the resources and tools to deliver quality and cost-effective care in a stable manner. Sadly, as this article exemplifies, the greater our focus on health economic rules, regulations, compliance, implementation and regulation, the less we are able to focus on research, education and patient care.
James H. Lubowitz, MD, is an orthopedic surgeon in Taos, N.M.
Disclosure: Lubowitz reports no relevant financial disclosures.
Penalties, decreasing reimbursement
The impact of MACRA and new, value-based payments may be more far reaching than just payment reform. The theory behind MACRA is good. It repeals the SGR formula, which never worked. Combining the three arduous existing quality programs — Physician Quality Reporting System, Value-Based Payment Modifier and Meaningful Use — should make reporting easier and should improve accountability for quality and outcomes. However, many smaller physician practices have struggled with implementing and understanding these measures and adding clinical practice improvement activities is not going to improve our ability to comply with reporting.
The orthopedic community has exceptional educational tools through the AAOS and the American Association of Orthopaedic Executives, but our administrative and IT teams are pushed to the limit trying to manage the daily operations of a practice in the increasingly complex world of human resources, financial management, insurance reimbursement and patient demands. We are trying to prepare, but do not feel like it can be given 100% of the effort that is required to excel. Other specialties, with less organized education and outreach, are at even more of a disadvantage.
Many practices, ours included, have had to add employees or increase employee work hours to comply with the current data entry requirements for Meaningful Use. Most EMRs have bits and pieces of all the requirements, but take a concentrated effort to combine all of the measures into a reportable file. The interface and licensing requirements for labs, radiographs, pharmacy and transfer-of-care documents are becoming increasingly expensive. Smaller practices have fewer physicians to spread the costs of additional IT infrastructure or a full-time quality/outcomes person to continue comply with these complex measures. If they are not successful, smaller practices will have penalties and decreasing reimbursement.
The end result of all of this will likely be less access for Medicare patients as smaller practices limit or eliminate treating these patients and fewer smaller independent practices as they merge with larger practices or become hospital employees.
E. Lyle Cain Jr., MD, is a managing partner at Andrews Sports Medicine & Orthopaedic Center in Birmingham, Ala.
Disclosure: Cain reports no relevant financial disclosures.