MACRA and managing change

Tags: gupta, president's letter, MACRA, practice transformation

By Ajay Gupta, MD
TAFP President, 2015-2016

As many of you are acutely aware, our health care delivery system is undergoing dramatic changes. For those of you who have been around as long as I have, this has been a similar theme for several years. One common phrase I have heard over the years is the idea of “change.” Many of us have been frustrated by the changes in the past. These changes have been unfavorable for family medicine. One thing is clear: the current system is broken and unsustainable.

Every day patients ask my opinion on these changes. Will it help family medicine? Will private practice survive? What’s going to happen to you and your colleagues? I respond by telling them I feel our current system is indeed broken.

The gap between us and our specialty colleagues has only increased. Personally, I have no issues with specialists or others who hold a job making what they make. While I do feel it’s unfair to a degree, I do not fault my colleagues. I do not fault entertainers and athletes for the same reasons. Most of us do not turn down money when it’s offered to us based on what is perceived as our value. I do feel the pot of money going into health care has gone up rapidly and is unsustainable. I am, however, more optimistic than before that the distribution gaps will narrow. Hopefully this translates into family medicine getting a higher percentage of the distribution than before. If we don’t shift to the right of the distribution curve, I fear more doctors will choose other specialties. This would be a horrible turn for our country and for our health care system. I feel there is more awareness of this potential exodus from family medicine at the national level. Value-based health care is here and no matter who takes over the White House, it’s here to stay.

There has been a lot written about the payment reforms stemming from the Medicare Access CHIP Reauthorization Act of 2015 – MACRA – and the effect it will have on us. While I see several issues with it, I do feel it provides a framework for placing a true value on the practice of family medicine. The trouble, of course, is in the details. The new system will require a higher level of data reporting. On a positive note, the data recorded is more specific and the process is more streamlined. CMS has committed to helping smaller practices get the support they will need and has recognized the need to commit resources to help practices decide what payment system to choose.

MACRA is actually rewarding practices that do quality reporting with higher payments. This is an increase from the current system in which these rewards will soon be phased out. Furthermore, the penalties for lower quality reporting will be less than those that exist now. For those of you who have already achieved medical home status, the work you have done will be recognized in the new MACRA system and can be used for data reporting. This is not the case in the existing system.

The most important thing that MACRA accomplished was to replace the annual SGR threat that would lower Medicare physician payments. This issue caused significant angst and utilized resources for all of us. It will be up to all of us to make sure that CMS follows through with its proposals and continues to value family medicine. There are still areas of MACRA that need improvement, but I am glad we finally have something that recognizes the value we bring to the system. For the first time in years, I am cautiously optimistic.

AAFP has created MACRA Ready, a resource to help make MACRA more understandable for everyone. Found on the AAFP site, MACRA Ready has videos and frequently asked questions ready to give an introduction to the changes coming with MACRA in 2019, as well as news and more in-depth breakdowns of policy changes. There are tools to break down the plentiful acronyms found throughout MACRA documentation, important procedural dates to look out for, and more. Sign up for AAFP’s email updates so you can be aware of any changes as soon as they take place.

At TAFP, educating our members about MACRA and helping you find the tools and resources you need to succeed in this new payment paradigm is the top priority of our communications department. Articles in Texas Family Physician, on, and in TAFP News Now have and will continue to explore the transition to value-based payment and how the new payment and reporting requirements for Medicare can be met. We have partnered with TMF Health Quality Institute to bring you the most up-to-date regulatory information from CMS and to introduce you to the many resources the organization offers free of charge. You can explore TAFP’s practice transformation resources at, including our video collection, “Family Physicians Embracing Change,” in which TAFP members describe their practices in alternate payment models.

We are also presenting MACRA education at our Annual Session and Primary Care Summit, November 4-6 in Dallas, so plan to join us. With these resources, you can feel confident in tackling MACRA alongside your Academy.

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