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Blog Post - More Doctors to Retire as MACRA and Value-Based Pay Hit

Published on 7th November 2016

More physicians are looking to shake things up or get out of the business altogether as new regulations and payment models are put into effect. 46% are planning to accelerate their retirement, cut back on patients, or swap out their position for less involved "non-clinical roles." That's according to the 2016 Biennial Physician Survey, published last September by the Physicians Foundation.

According to the survey, which is conducted in cooperation with recruitment firm Merritt Hawkins across a population of more than 17,000 physicians, 21% of the aforementioned 46% say they will cut back on hours, while 13.5% will be seeking non-clinical jobs. Meanwhile, 14.4% are actively planning to retire within the next one to three years; a whopping 5% increase from 2014, when the previous Biennial Physician Survey was published. The reason, says Dr. Walker Ray, president of the Physicians Foundation, is widespread "poor morale."

"Many physicians are dissatisfied with the current state of the medical practice environment," Dr. Ray said in a statement released alongside the survey, "and they are opting out of traditional patient care roles."

The main cause of this dissatisfaction, according to the survey, are the "invasive regulations" being enforced by new government programs. Payment models are moving away from traditional fee-for-service in favor of value-based pay models, which require physicians to be measured and reimbursed by insurers based on quality of care and health outcomes. Aetna, Anthem, UnitedHealth Group, and Blue Cross and Blue Shield have already moved towards value-based models; a significant shift reflected in the 43% of physicians whose pay is tied to these new models.

The bulk of these changes were put into effect by the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, and its Quality Payment Program. According to CMS.gov, the Quality Payment Program improves Medicare by allowing physicians to "focus on care quality and the one thing that matters most – making patients healthier." It ends the highly-unpopular Sustainable Growth Rate formula, which cut Medicare payments to physicians, and offers two new tracks: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs). Both utilize a physician quality reporting system, a value-based payment modifier, and the "meaningful use" electronic health record technology.

The Quality Payment Program is just one part of the Quality Measure Development Plan (MDP), a self-described framework to help "build and improve quality measures for clinicians." Yet according to the 2016 Biennial Physician Survey, nearly half of the surveyed physicians view the new models as more of a hinderance than a boon.

What's more, despite the Medicare Access and CHIP Reauthorization Act being finalized on May 2 of this year, only 20% of surveyed physicians were familiar with MACRA. Meanwhile, 56% identified as "somewhat unfamiliar" or "very unfamiliar."

Such unfamiliarity, along with the general resentment being expressed among physicians, seems endemic to the changes brought about under the Affordable Care Act, including MACRA and the Quality Measure Development Plan. According to Mark Smith, president of Merritt Hawkins, the issues are myriad and have been present for some time.

"Doctors have been on a slow boil over a variety of issues for years," Smith says in the survey. "Implementing value-based care and adjusting to MACRA on the fly has turned up the heat a few more degrees. The result is more than hard feelings."