Physician readiness for MACRA

2016 Survey of US Physicians
Physician awareness,
perspectives, and readiness
for MACRA

2016 Survey of US Physicians:
Physician awareness, perspectives, and readiness for MACRA
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a Medicare payment law
intended to drive health care payment and delivery system reform for clinicians, health systems,
Medicare, and other government and commercial payers. The law establishes a path toward a new
payment system that will more closely align reimbursement with quality and outcomes. MACRA applies
financial incentives for health care professionals to participate in risk-bearing, coordinated care models
and to move away from the traditional fee for service system. MACRA’s final rule from the US Centers
for Medicare and Medicaid Services (CMS) is expected in fall 2016, and the first performance reporting
period under the law begins January 1, 2017.
Deloitte’s 2016 Survey of US Physicians sought to shed light on physicians’ awareness of MACRA, their
perspectives on its implications, and their attitudes and readiness for change. The survey found that
many physicians are unaware of MACRA. Regardless of their awareness level, most physicians surveyed
would have to change aspects of their practice to meet the law’s requirements and to do well under its
incentives. Many physicians surveyed recognize they will need to bear increased financial risk (under
MACRA and in general) and need support and resources to develop the capabilities do so.
Copyright © 2016 Deloitte Development LLC. All rights reserved.Source: Deloitte 2016 Survey of US Physicians

Most physicians surveyed are unaware of MACRA. Independent
physicians surveyed are more aware of it than others.
Surveyed physicians with a high share of Medicare
payments are just as unaware of MACRA as others.
21% of self-employed physicians and those in
independently owned medical practices report they
are somewhat familiar with MACRA versus 9% of
employed physicians surveyed.
This may be because self-employed and independent
physicians are more directly responsible for their
practices’ business requirements.
50% of non-pediatric
physicians surveyed have
never heard of MACRA.
32% only recognize
the name.

Many physicians surveyed recognize they will need new capabilities in order
to bear increased financial risk.
The announcement by CMS of $100 million for training and education of small practice physicians to
understand the Quality Payment Program is well timed and needed to help physicians prepare for MACRA.
Copyright © 2016 Deloitte Development LLC. All rights reserved.
Top needed supporting capabilities reported by surveyed
physicians are related to reporting and include:
Standardized quality
measures
42%
Analytics and other
monitoring tools to track
high-cost patients
29%
Standardized
cost measures
28%

Surveyed physicians reported that they
prefer traditional compensation models.
Nearly 8 in 10 physicians surveyed
prefer fee-for-service or
salary for their compensation.
Many physicians surveyed will have to adjust their current approach and practice
management based upon MACRA’s specifications. For example they
have low preference for most value-based payment models.
of physicians surveyed would opt for
shared savings, which is not a qualifying
Advanced Alternative Payment Model
(APM) under MACRA.
of physicians surveyed would participate
in value-based payment models if
offered financial incentives to do so.
Performance bonuses currently are less than
10% of current compensation or non-existent
for majority of physicians surveyed.
of physicians surveyed report
receiving performance bonuses
that are less than or equal to
10% of their total compensation.
of physicians surveyed report
that they are not eligible
for performance bonuses.

The majority of surveyed physicians believe
that the performance of the US health care
system can be improved by:
Half of surveyed physicians
do not support individual public quality
reporting as would be required under the
Merit-Based Incentive Payment System
(MIPS) track of MACRA.
74% of surveyed physicians believe performance
reporting to be burdensome and 79% do not
support tying compensation to quality.
Performance reporting is supported conceptually but public reporting
at the individual level is not and surveyed physicians find reporting burdensome.
Measuring care outcomes
and processes
Measuring resource
utilization and costs
73% 71%

Surveyed physicians open to participating in value-based payment models have more
positive expectations for MACRA and health care transformation more generally.
After receiving a brief explanation of MACRA, 23%
of surveyed physicians who are willing to participate
in value-based payment models with financial
incentives indicated that the law would reduce costs,
and 19% indicated it would improve quality.
Among physicians surveyed willing to participate in
value-based payment models with financial incentives,
47% believe that value-based payment models can
improve the performance of the US health care system.
Only 23% of surveyed physicians who are unresponsive
to incentives believe in value-based payment models.
Of those surveyed physicians who are unresponsive
to incentives, only 9% felt that the law would reduce
costs, and 5% said it would improve quality.

Most surveyed physicians expect increased physician consolidation, but independents
would prefer joining clinical networks versus being employed. Increased consolidation
is expected due to financial pressures in general, not just MACRA.
Copyright © 2016 Deloitte Development LLC. All rights reserved.Source: Deloitte 2016 Survey of US Health Care Physicians
58% of physicians
surveyed
would opt to be part of a larger
organization to diminish individual
physician risk and bear risk
collectively and/or to have access
to a full spectrum of resources
and capabilities.
80% of those
surveyed
expect MACRA to drive
physicians to join larger
organizations or networks.
Half of surveyed
physicians
say financial pressures
are the number one driver
of consolidation.
Both independent and employed physicians surveyed
expect that between a third and two-thirds of the
remaining independent physicians will consolidate in
the next three years.
One in four
of independent physicians surveyed would
prefer to be employed while 75% would prefer
to join a clinical network.

Methodology
Since 2011, the Deloitte Center for Health Solutions has surveyed a nationally representative sample of US physicians
on their attitudes and perceptions about the current market trends impacting medicine and future state of the practice
of medicine. The general aim of the survey is to understand physician adoption and perception of key market trends of
interest to the health plan, provider, life sciences, and government sectors. The 2016 survey included 600 US physicians
and had new questions on MACRA. The national sample is representative of the American Medical Association (AMA) file
with respect to years in practice, gender, geography, practice type, and specialty to reflect the national distribution of US
physicians. A subsample of 523 physicians (non-pediatric specialties) were asked specific questions regarding MACRA
since it specifically targets Medicare payments. The entire sample of 600 were asked about value-based payment models
and consolidation.
For more information, please visit: www.deloitte.com/us/macra
Copyright © 2016 Deloitte Development LLC. All rights reserved.Copyright © 2016 Deloitte Development LLC. All rights reserved.Source: Deloitte 2016 Survey of US Physicians

About the Deloitte Center for Health Solutions
The source for health care insights: The Deloitte Center for Health Solutions (DCHS) is the research division of Deloitte
LLP’s Life Sciences and Health Care practice. The goal of DCHS is to inform stakeholders across the health care system
about emerging trends, challenges, and opportunities. Using primary research and rigorous analysis, and providing
unique perspectives, DCHS seeks to be a trusted source for relevant, timely, and reliable insights.
To learn more, please visit: www.deloitte.com/us/centerforhealthsolutions
Copyright © 2016 Deloitte Development LLC. All rights reserved.Copyright © 2016 Deloitte Development LLC. All rights reserved.Source: Deloitte 2016 Survey of US Physicians

Contact us
Mitch Morris, MD
Vice Chairman
Global Life Sciences & Health Care Industry Leader
Deloitte Consulting LLP
mitchmorris@deloitte.com
Anne Phelps
Principal
US Health Care Regulatory Leader
Deloitte & Touche LLP
annephelps@deloitte.com
Wendy Gerhardt
Research Manager
Deloitte Center for Health Solutions
Deloitte Services LP
wgerhardt@deloitte.com

About Deloitte
Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of
member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities.
DTTL (also referred to as “Deloitte Global”) does not provide services to clients. Please see www.deloitte.com/about for a detailed description
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Copyright © 2016 Deloitte Development LLC.
All rights reserved. 36 USC 220506
Member of Deloitte Touche Tohmatsu Limited

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