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Macra and MIPS, is it the end of private practice?

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  • Macra and MIPS, is it the end of private practice?

    Have been trying to make my way through Macra and MIPS, increasingly concerned that in 10 years private practice will be dead.  Seems like the underlying goal is to limit access to care and reduce physician compensation when we account for something like 10% or less of all healthcare dollars. Anyone with a better handle on the Macra or MIPS able to give us a breakdown.  Not looking for some government or organizations bureaucrat's opinion Looking for WCI physicians who are looking at up coming changes and making moves now that will allow us to survive.


  • #2
    I don't quite understand it all, I do agree the end goal is to reduce physician compensation

    Given the way all healthcare related policies are rolled out, I'm hoping for a slow and butchered introduction

    In the meantime, I'm hoping to squeeze out what I can and then transition to a cash-only boutique practice or return to academics or simply retire


    • #3
      I've been trying to understand the changes as much as I can but from what I understand the details of the different " alternative payment models" really haven't been defined (even though it's law that it's being implemented in a fairly quick roll out fashion).

      I think that private practice in general will be dead, as "integration" will be the key word. I think the effect on compensation will be how much leverage groups or specialties have with hospitals. Hospitals will control things so some specialties will be more crucial to the hospital survival than others.. Things like ability to recruit (rural, ect ) as well as group dynamics (quality, good behavior) will be important. Stuff like co management and call coverage compensation will become more important.

      The best site that I've found is a cardiology consulting firm that has some good blogs on macras, ect.. Can google medaxiom and macras and should take u there.


      • #4
        I heard a talk at my specialty national conference this year.  The speaker who was an MD and had worked for health insurance agencies was quite certain that the "losers" in MACRA and MIPS would be solo practitioners.  "Losers" meaning those chronically in the lower 10% who have to be penalized.

        To deal with the administrative requirements to show one is meeting quality metrics is at least a full time position of an highly trained individual and a solo practitioner cannot afford that.


        • #5
          As it's written, the new legislation is definitely against solo/small practice in terms of penalties. They even stated that they estimate 87% of solo practices would get the penalty. Was reading an article in Medical Economics magazine today and they basically said that the small practices would be subsidizing the larger ones from the penalties with it being "budget neutral" or whatever term they use.  It also said practices would need to hire a full time clinical nurse, IT person and pharmacist (really??) to comply with the measures.   I foresee practices just opting out of medicare/aid to avoid it altogether. Then there will be pushback from the gov't when there is a shortage of providers taking medicare and more restrictive/useless regulations.  It's always a tug of war.   Bigger problem will be if the commercial insurers also start following CMS and doing the same things - anyone know if that will be the case?

          Been thinking hard about starting own practice for a while, but now that I (kind of) know what MACRA/MIPS entails, makes me more nervous.  Medicare percentage in the practice would be low though, like makes me think it could still work.  Just have to adapt and work within the private practices have always done