Home Forums Discussions General Discussion MIPS Track 1 and Track 2

So, as a solo physician in private practice, I'm having trouble keeping my spirits up after reading the latest Medical Economics. It's all about Population-based heatlhcare. They discuss the MIPS program, ACO's, AAFP and ACP supporting MIPS, new payment models, the end of fee-for-service, how you need a whole 'team' of extra staff to do population medicine, and yes, how you can start looking for work at a hospital or large organization instead of a small practice. Under the present administration, the tide continues to move toward the government and large corporation controlling healthcare and the legion of drone workers doing the operations. The whole move is just capitation, which transfers the risk from the insurer to your organization. All of this when the USPSTF cannot even prove that a wellness exam is a good use of a patient's time or money.

So, track 1 will give you a smaller fee-for-service and you get $2.5 per patient per month on Medicare.
Track 2 gives you a much smaller fee-for-service and you get $4 per patient per month.

All of this from an organization that brought us the debacle* that was Meaningful Use. I'm wondering if we will be forced to pick a track, or if the present system will continue. I think there will be NO straight fee-for-service with Medicare. If the reimbursement gets much worse, I will just drop Medicare.

*a sudden and ignominious failure; a fiasco.

I have read several articles about it and at this point my conclusion seems clear... I will be opting out.

I'm wondering if we can opt out from the MIPS system, or if we would have to pick a track or opt out of Medicare all together.

Looks like if you just ignore it that by 2019 your medicare/medicaid payments will drop by somewhere between 6-9%.
In my practice Mcare Mcaid makes up about 50% so practice income will drop by 4.5%
The wild card will be if commercial payers latch onto it, if that happens F me.

I am also a solo physician and share your concerns. I went and spoke to a local large physician employer and felt sick after the conversation. That is simply not going to happen. I am going to work hard to reduce my percent of Medicare over the next 3 years in anticipation of opting out. I see no real alternative at this point. Our only hope is that this gets stalled and delayed like everything else Medicare does. I am also thoroughly dismayed that the AAFP would embrace this program so whole-heartedly. They have let us down and we should let them know it.

I'm also in a solo practice and in the same boat. My plan is to just close the office and work part time when things get bad enough. It's too bad because I've built a nice practice and have several people depending on me for jobs.

This is a pretty good article: http://medicaleconomics.modernmedic...l-practices-likely-be-losers-under-macra . One thing that strikes me is that CMS is predicting 87% of solo docs will fail the MIPS guidelines and receive penalties. Basically MACRA is putting us in a position they know we won't win.

The comment period on MACRA is open until June 26th and I'd encourage people to leave comments on the bill. My suggestion would be exempting groups under 10 docs from the guidelines. I also sent a copy of my comments to my Senators and Congressman, and ended up talking to one Senator's office. Whether it will do any good who knows but it can't hurt.