01/17/2018
Important information regarding MIPS for small practices. The article is informative but bottom line is, for a small practice Medicare is requiring reporting on 200 patients or $90,000. It's not great news, but it's better than they had proposed. It's a hassle, I know.
While private practices reported a per physician operating margin of $16,378, integrated health systems saw per physician operating losses of $31,957 from 2016 to 2017.
Practice size also had an impact with small and mid-size groups reporting increased operating losses per physician, while larger groups saw operating loss decline.
“The results of this survey suggest that groups must be diligent in managing their operational imperatives of their organizations,” Fred Horton said in a statement.
“Without real focus on operational costs and processes, there is a significant inability to grow revenues in a manner that will outpace practice inflation.”
The findings dovetail with the financial struggles hospitals are experiencing in today’s healthcare cost environment.
Both nonprofit and for-profit hospitals are seeing revenue decline and losses mount as new reimbursement models emphasize shorter stays and more care delivered in outpatient settings.
In addition to finances, smaller physician groups also worry about the burden of MACRA reporting. Small and rural providers have repeatedly said their lack of capital and resources make complying with the reporting requirements a serious strain on financials.
In an effort to accommodate smaller provider concerns, CMS raised the low-volume threshold for MIPS participation from $30,000 in Medicare Part B charges or 100 Medicare patients to $90,000 or 200 patients.
The change, finalized in the fall, is expected to exclude about 134,000 clinicians from MIPS, adding to 800,000 already exempted from the program.
Still, despite the potential hardship on providers, AMGA has opposed CMS’ increasing flexibility around MACRA/MIPS. In comments on the Quality Payment Program proposed rule implementing MACRA, AMGA said loosening requirements needlessly delays the shift to value-based care and “fails to recognize the significant investments made in preparation for participation” in MACRA.