A significant number of ophthalmologists and optometrists practice solo or in smaller group settings. Many national physician organizations feel that MACRA will increase the burden on solo/small practices, which have fewer resources at their disposal than large groups and health systems. CMS defines “small practices” as those with 15 or fewer clinicians.
Why? Through MACRA’s “virtual groups” rule, Congress established the ability of solo and small groups to join forces and report their data as a group in an effort to level the field using economies of scale. But CMS has delayed the implementation of virtual groups until at least 2018, citing a need to work out the details. The lack of virtual groups could prevent them from participating on equal footing in the MIPS program, widening the gap between smaller and larger practices, and those affiliated with health systems, at least for the first year.
CMS originally projected that 87 percent of solo practitioners and nearly 70 percent of those in practices of 2-9 physicians will receive a negative adjustment in 2019. But these figures are incorrect, CMS Acting Administrator Andy Slavitt says, because they’re based on 2014 PQRS data, and many solo/small practices were not reporting at that time. Meanwhile, CMS offers this fact sheet detailing its support for small practices under MACRA including:
- $100 million over five years in technical support. CMS will focus practice located in rural or health professional shortage areas.
- The Healthcare Payment Learning and Action Network. This public/private partnership offers resources (discussion forums, workgroups, webinars, etc.) for small practices seeking to transition to APMs.
- The Transforming Clinical Practice Initiative. This 658-million-dollar project encompasses 39 national and regional networks aimed at helping clinicians improve quality, coordinate care, and better use thier resources, mainly through peer-to-peer support.