If you are planning on complying with Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), make sure to allot the appropriate time and funding necessary to update/upgrade your practice. Realize that the measures will be arbitrary, the data implementation arduous and the moments for live patient care fleeting. Expect that, no matter how Herculean the task may be, the finish line will move often and unexpectedly. Prepare to get discouraged when your software needs to be updated, maybe every year, at a cost. At least someone will be profiting from all this wheel-spinning.
Check, double check and triple check the data. There will be a host of governmental administrators waiting to disqualify your practice based on technicality. Dot all the i’s and cross all of the t’s. Remember that somewhere out there is a person whose sole purpose is to find errors in your work and punish you. Their bonus depends on it.
Above all, don’t forget that it is your patients that are most important. All these extra hours and dollars won’t make a spit of difference in their well being. So you may want to squirrel away more personal time to do what you used to do all day long before you agreed to these fanciful rules and regulations — best of luck.
If you are planning to join an accountable care organization or medical home, consider hiring more staff to manage the extra burden. What with the health coaches and life experts, it is guaranteed your payroll will swell. When not conducting team huddles and combing the data for trendspotting, you, of course, will get back to the business of helping patients with those difficult medical problems. You might feel the urge to expand to cover increased costs, but in reality, you will be pushed to have smaller panels and see people less often. Why have a billable visit to a physician when the government can get off cheap by using a coach instead? They should be able to handle heart failure, right?
The bonus payments will cover the shortfall. At least fifty percent the first year — until the requirements get harder. But it’s all for the greater good. So you’ll work it out somehow.
If your goal is to sell your practice to a big medical group — congratulations. Don’t expect to receive more than pennies on the dollar. The days of getting a fair-market value are long gone. There are federal regulations, you know? You wouldn’t want to be accused of inducement. I’m sure the transition will be flawless and your salary guaranteed … for a time.
You might get to keep that favorite nurse or secretary. Much of everything else will change, though. Your medical record, your hours and your payer mix. You will work more for less pay and lose control over your day-to-day activities. At some point, you may realize that all that money you are making for the practice is now going to some administrator or another — definitely not to you.
At least someone else will have to worry about all those details you loathed so much. You are paying them to worry.
And if you are working towards completing your maintenance of certification activities for the ABIM …
Wait. Wait. Does this all sound fairly miserable to you? It does to me. So do something!
I’m not talking about filling out a silly form and sending it to the government (although that sometimes works too).
Remove yourself from the abuse. Extirpate your income from Medicare and insurance companies. It’s more possible than you think. There are at least a hundred different ways to do this.
I’m doing five of them right now.
Are you going to roll over and play dead?
Or are you going to do something?
Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.
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