22 December 2016

Practice Management Changes in 2017

A new Physicians Practice article, “7 Predictions for Practice Management in 2017,” features several respected healthcare experts including Sheridan’s Chief Quality Officer, Gerald A. Maccioli, MD, MBA, FCCM. Their predictions addressed seven areas of anticipated change:

  • The Affordable Care Act and congressional action
  • New data and deadlines
  • Shifting payments
  • Added regulation
  • Changing insurance scene
  • Technology demands
  • Patient communication

Dr. Maccioli spoke about the modifications to the phase-in year of MACRA made by CMS to address the physician community’s “angst” about the program’s implementation, including technology and operational issues such as data collection, auditing and validation. MACRA payments will come via the Quality Payment Program (QPP) which has a choice of two tracks, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Rather than giving physicians a hard start date requiring full participation to avoid penalties, as in previously proposed versions, the final rule offers clinicians three options for year-one participation in MIPS without being at risk for a penalty. Physicians may choose to use 2017 to test the program by submitting some data during the calendar year, or submit information for part of the year with some opportunity for bonus, or participate for the full year with an opportunity for a larger bonus. Dr. Maccioli called the flexibility offered by the final rule “a real relief” to the medical community. The alternative to MIPS is participation in one of the APMs, such as Medicare Shared Savings Track 2 or 3 in 2017, which offer the opportunity for a 5 percent incentive payment in 2019 if certain thresholds are met for receiving enough Medicare payments or seeing enough Medicare through the APM. 

Dr. Maccioli also raised the proposed mergers of insurers, such as the proposed Aetna-Humana merger and the proposed Anthem-Cigna merger, which he says will affect both physicians and patients. While several of the big insurance companies are currently in legal battles with the Department of Justice, if they merge it will have serious implications for physicians' ability to negotiate and will limit patient choice.