From the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (TGS); Department of Health Administration and Policy, George Mason University, Fairfax, VA (DGG, AEC); Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (AJK).
J Am Board Fam Med. 2020 Nov-Dec;33(6):942-952. doi: 10.3122/jabfm.2020.06.200142.
Despite major efforts to transition to a new physician payment system under the Medicare Access and CHIP Reauthorization Act (MACRA), little is known about how well practices are prepared. This study aimed to understand how small and medium-sized primary care practices in the Heart of Virginia Healthcare (https://www.vahealthinnovation.org/hvh/) perceive their quality incentives under MACRA.
This study analyzed data from 16 focus-groups (70 participants), which yielded a range of physician, advanced practice clinician, office manager, and staff perspectives. Focus-groups were audio-recorded and transcribed, then imported into NVivo for coding and analysis of themes. A multidisciplinary research team reviewed the transcripts to maximize coding insights and to improve validity.
The main findings from the focus-groups are: 1) MACRA awareness is relatively higher in independent practices, 2) steps taken toward MACRA differ by practice ownership, and 3) practices have mixed perceptions about the expected impact of MACRA. Two additional themes emerged from data: 1) practices that joined accountable care organizations are taking proactive approaches to MACRA, and 2) independent practices face ongoing challenges.
This study highlights a dilemma in which independent practices are proactively attempting to prepare for MACRA's requirements, yet they continue to have major challenges. Practices are under extreme pressure to comply with reimbursement regulations, which may force some practices joining a health system or merging with another practice or completely closing the practices. Policy makers should assess the unintended consequences of payment reform policies on independent practices and provide support in transitioning to a new payment system.
尽管在《医疗保险获得和儿童健康保险计划再授权法案》（MACRA）下做出了重大努力以过渡到新的医师支付系统，但对于实践准备情况了解甚少。本研究旨在了解弗吉尼亚之心医疗保健中心（https://www.vahealthinnovation.org/hvh/）的小型和中型初级保健实践如何看待其在 MACRA 下的质量激励措施。
本研究分析了来自 16 个焦点小组（70 名参与者）的数据，这些数据产生了一系列医生、高级实践临床医生、办公室经理和员工的观点。焦点小组进行了录音和转录，然后导入 NVivo 进行编码和主题分析。一个多学科研究团队审查了转录本，以最大限度地提高编码见解并提高有效性。
焦点小组的主要发现包括：1）独立实践对 MACRA 的认识相对较高，2）采取的步骤因实践所有权而异，3）实践对 MACRA 的预期影响持混合看法。数据中还出现了另外两个主题：1）加入问责制医疗组织的实践正在积极采取措施应对 MACRA，2）独立实践面临持续挑战。
本研究强调了一个困境，即独立实践正在积极主动地尝试为 MACRA 的要求做准备，但它们仍然面临重大挑战。实践面临着遵守报销法规的巨大压力，这可能迫使一些实践加入医疗系统或与另一个实践合并，或完全关闭实践。政策制定者应评估支付改革政策对独立实践的意外后果，并为过渡到新的支付系统提供支持。
