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MACRA-Part 3: The Toxic Side Effects

MACRA-Part 3: The Toxic Side Effects

MACRA – Part 3: The Toxic Side Effects

In the Part 2 Blog in this series, the critical success factors for MACRA were identified. Although they are challenging, they can all be eventually achieved if they have the full support of the physicians. It would seem that all physicians would support achieving the components of the value equation for all those that they serve, that being improving clinical quality and service quality, while controlling or reducing costs. And, in addition, it seems to make great sense that the way to assure sustainable value is to align the payment model with the achievement of metrics which sets best practice goals for each of the components.

Unfortunately, physician's support, which seems so simple and reasonable on the surface, will be hard to achieve. Why? Because MACRA is contributing to an increasing number of extremely dissatisfied physician's, a significant toxic side effect of CMS’s payment reform program.

In a recent study commissioned by the Physician Foundation, it was showed that 1 in 2 physicians are demoralized or dissatisfied. More detailed findings of this study were reported on the September 19, 2016, Web Page of the Heath Leaders Medical News. Specifically, it highlighted the following:

Medical doctors are largely overwhelmed by their work and disengaged from key healthcare reform measures such as value-based payments, accountable care organizations, and electronic health records
Half of physicians are disengaged burned out, and demoralized, and plan to either retire, cut back hours, or seek non-clinical roles
Many physicians are dissatisfied with the current state of the medical practice environment and they are opting out of traditional patient care roles
The implications of evolving physician practice patterns for both patient access and the implementation of healthcare are profound
The majority of the 17,236 physicians surveyed (54%) describe their morale as somewhat or very negative. 63% are pessimistic about the future of the medical profession, and 49% would not recommend medicine as a career to their children

Because this study is depicting the realities of the physician environment today, integrating physicians positively will be a steep mountain to climb. Yet, it is so critical for success that one our first blogs published nearly four years ago was a four part series on this exact topic. Because establishing strong physician partnerships continued to be the number one priority of healthcare leaders, two years ago we published a two part blog series entitled, Strategies to Put Physicians on the Offensive. It probably would be worth your time to go back and review these blogs once again. They will remind us all that strategies must be developed to “connect the physicians” so they can respond as well-informed professionals, putting forth their positions based on careful analysis of accurate data. Some of the strategies that we put forth, having used them successfully, included:

Let the physicians know during your interactions with them that you understand why they are angry, and in fact, they may have good reasons for some of their negativity
Also, let them know that some of the things being done to them by the “enemy” are wrong and do not make logical sense
But quickly reaffirm for them that there is a significant amount of poor quality and high costs associated with the healthcare product, often resulting in the overuse or misuse of clinical resources. They must accept that such outcomes are no longer acceptable, hence, agreeing that changes must occur
Let doctors know that they are in the “driver’s seat”, since they write the orders, demand the level of labor costs, and direct the types of clinical supplies purchased and utilized. Therefore, they must take a leadership role to improve quality, safety, patient satisfaction, and cost.
Reaffirm for them that little good and few sustainable changes come from being on the “defensive”
Therefore, encourage them to go on the “offensive”,giving them concrete examples that have worked, including a significant delay in the MACRA implementation calendar due to the feedback to CMS from 4000 providers.

In summary, the anger which many physicians are expressing today is real and must be recognized. But successful payment reform driven by the Value Equation will only be achieved by enhancing physician integration, convincing them to become active partners in this continuing journey. This is best accomplished by identifying and implementing proven strategies to move physicians to the offensive, utilizing their voices to help develop solutions to the many challenges facing the healthcare industry today! They will not be satisfied or successful sitting in the back seat. They are the drivers!