ACO Participation Has Almost Leveled Off
Participation in accountable care organizations (ACOs) mushroomed from 3% to 24% in Medscape reports from 2012 to 2014, but the rate of growth since then has been about three or four percentage points a year, leading to the 2017 participation level of 36%.
ACOs are slowly becoming more successful at winning shared savings but they still have to prove that they are an effective mechanism, according to a report in a Health Affairs blog last September. Based on performance in 2015, the latest data available, 31% of ACOs earned shared savings bonuses for 2015 performance, compared with 27% in 2014.
Even though many ACOs are run by hospitals, the report said that those that were physician-led, integrated, and smaller tended to perform better than the rest. "The 2015 results underscore the challenge in transitioning to a high-quality, high-value delivery system but also show that progress is possible," the authors concluded.
Physicians Revolt Against MACRA
Medscape survey results show a widespread distaste for requirements under the Medicare Access and CHIP Reauthorization Act (MACRA), which began in January.
Only 43% said they would participate in MACRA, while 35% are still undecided. Depending on the specialty, 25%-80% of doctors won't participate.
This means that substantial numbers of physicians are not reporting performance scores to CMS, as MACRA requires, and these physicians will see their reimbursements cut in 2019.
While some physicians can enter an advanced track of MACRA that does not require reporting, the vast majority are in MACRA's Merit-Based Incentive Payment System (MIPS), which requires reporting of various measures, including the new versions of meaningful use under the Physician Quality Reporting System (PQRS). If physicians do not report data or if their performance scores are low, they could lose up to 4% of their Medicare reimbursements in 2019, and that amount would rise in subsequent years, to 9% in 2022 and afterwards.
Physicians are getting a break this year. Facing criticisms from physicians, CMS announced last September that it would loosen MIPS reporting requirements for 2017. Doctors can avoid the 2019 penalty by merely reporting some quality and cost data, or they can submit data for just part of the year. This latter option means that physicians who are not reporting may still have time to change their minds and report later in the year.
Will the Trump administration save physicians from MIPS? Health and Human Services Secretary Tom Price has been silent about how he will handle the new program, but in any case, changing reporting requirements would probably require an extensive rule-making process.
Physician participation in MACRA varies widely. In the Medscape survey, the lowest participation rates are for psychiatrists (19%), plastic surgeons (25%), and pediatricians (33%), physicians who have little or no participation in Medicare. Specialties with the highest participation rates are ophthalmology (64%), nephrology (61%), and urology (61%). Lower on the list are family physicians (49%) and internists (43%).
Even the highest participation rates mean that one third haven't committed to the program. As time passes, La Penna thinks more physicians will get used to quality reporting, particularly if they are paid for high performance. Under MIPS, physicians who have higher-than-average scores will be awarded up to 4% more in 2019, plus extra bonuses.
He reports that many physicians are already making a substantial amount of money from quality programs run by commercial payers, ACOs, and other entities. In return for meeting protocols for making referrals, deciding treatment, ordering lab tests, and not referring patients to expensive specialists, some of these doctors are making tens of thousands of dollars a year.
For example, a family physician he advises recently got a check for $100,000 for meeting targets last year. "Getting a check of that size makes you very happy," he says.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Leigh Page. Doctors' Incomes Are on the Rise -- Is Yours? Medscape Physician Compensation Report 2017 - Medscape - Apr 04, 2017.