Q&A: Half of physicians in survey don’t know about MACRA

Out of 600 non-pediatric physicians surveyed by the Deloitte Center for Health Solutions, only 50 percent were aware of the Medicare Access and CHIP Reauthorization Act (MACRA), despite the fact it will dramatically change Medicare reporting beginning in 2017.

Self-employed physicians and those in independently owned practices were slightly more aware of the coming reimbursement changes, with 21 percent saying they’re somewhat familiar with it, compared to just 9 percent of physicians employed by hospitals or large practices.

Physicians with a high share of Medicare payments—who will be affected the most by MACRA’s changes—were just as likely to be oblivious as other doctors.

How could physicians be unfamiliar with such a major change to Medicare? What does it say about CMS’s education efforts? To answer those some of those questions, HealthExec spoke with Sarah Thomas, managing director of the Deloitte Center for Health Solutions.

HealthExec: Half the physicians responding to your survey said they weren’t aware of MACRA. What explanation could there be for a lack of awareness on such a big program?

Sarah Thomas: I think a lot of physicians are heads down, focused on their day-to-day on their practice and the practice requirements, and simply haven’t had the chance to hear from their specialty societies and local groups about the law and its implications.

I think that if you said to most doctors, “Did you hear the SGR (sustainable growth rate) was fixed?” we didn’t ask that specific question but they might have heard that. But have they heard about what was put in place to replace it? I think that was a really interesting answer that we found.

I also thought an interesting finding related to the awareness question was that physicians who are working in part of larger organizations were less likely to have heard about that law. In that case, it may be simply they feel that their larger organization is going to take care of any big changes that they need to deal with, and so they may not themselves have to deal with it in their practices.

For the doctors who weren’t aware of MACRA, how was the law then explained to them in your survey?

We gave them short descriptions of elements of the law. We sort of chunked it out. We spent a fair amount of time in trying to not overwhelm them with the technical details, but give them, at a very high level, some of the features of the law.

The question we asked them specifically at the beginning of the survey, before we started explaining what it was, was “How familiar are you with the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 and its requirements?”

And the options were:

• I have never heard of it.
• I recognize the name but I’m not familiar with its requirements.
• I’m somewhat familiar with this law and its requirements.
• I have in-depth knowledge of this law and its requirements.

In your opinion, is it a problem that physicians aren’t aware of MACRA?

Interestingly, we found that physicians for whom Medicare is a major payer were just as likely to be unaware, so I do think it shows the need for both policymakers and people who are working with physicians to be successful under MACRA to accelerate educational activities, because clearly there’s a gap between awareness in the practices and readiness for implementation of this important law.

Moving onto broader topics the surveyed tried to address, what were physicians’ general feelings about value-based care?

We asked questions about value-based care in our physician surveys this year and two years ago, and it has not changed very much.

Most physicians prefer fee-for-service or salary. Nearly eight in 10 physicians told us that was their preferred means of compensation. There was very little change in the amount of physicians who get their compensation from performance bonuses. About 50 percent get 10 percent or less.

There was some interest in participation in value-based care. Seventy percent of physicians said they’d accept a value-based care payment model. The preference was for shared savings arrangements—about half of them said that they would be acceptable, particularly with no downside risk.

You found that 74 percent of surveyed physicians consider performance reporting to be a burden, but many supported reporting conceptually, with 73 percent saying measuring care outcomes can improve the performance of the healthcare system. Why does that disconnect exist?

We definitely saw that gap. I think where it breaks down is questions we asked around burden and also tying individual physician compensation to quality. We also got some answers to some questions about whether the measures capture what you do as a physician which indicate that might be another area that explains the gap.

In other words, even though in concept, reporting quality measures or looking at data and being measured is OK, the specific quality measures that might be in current use might not represent to a physician what he or she is accomplishing.

All of these results—the lack of awareness on MACRA, favoring fee-for-service over value-based care—how can these inform CMS’s education efforts when trying to get doctors prepared for MACRA?

I think that it illustrates that CMS’s funding and partnerships with physician organizations are exactly what they should be doing right now to get ready.

But it’s hard. I think physicians are, as I mentioned earlier, they’re busy in the practice, and they’re heads down seeing patients. I think creating mechanisms to communicate with those physicians can be challenging, but leveraging the specialty societies and the other groups that work with physicians on a regular basis seem to be a part of CMS’s strategy, and it seems like it’s an important step.

I do think, particularly for physicians who are employed and working in health systems, leveraging those health systems who will be doing a fair amount of the work on implementation, so it’s not just about reaching out to the individual physicians, but to the variety of organizations who work with physicians, whether it’s on an organizational level or a membership level.