A HEADLONG RUSH TO CONSOLIDATE For physicians like Dr. Snyder, whose HeartPlace group will make every effort to succeed under the new sys- tem, a more insidious devil lurks in the details. Given the administrative requirements, costs, and hassles of compliance, he says, many practices “won’t be able to resist the temptation” to sell out to hospitals and large health systems that will manage the problem for them. “In Texas, more than 60 percent
of patient care physicians are in very small practices of one to three physi- cians,” according to TMA’s MACRA position statement. “MACRA is very likely to levy penalties on most of them, pushing some or all of them over time to retire, or join large groups or hospitals. ... Such a huge disruption in the ambulatory care environment might be justified if there were evi- dence that the changes would result in better or more efficient care, but the evidence that exists does not support that notion.” Dr. Snyder says his practice is in-
trigued by the possibility of following the APM path under MACRA. That path offers bigger bonuses to physi- cians engaged in alternative payment models, such as eligible accountable care organizations, certain patient- centered medical homes, and some bundled payment models. But even for large practices such
as his, Dr. Snyder foresees an “accel- erated consolidation of independent physicians going into hospitals.” He pushed Mr. Gronniger to come up with an “independent practice path- way” for success as an APM. “We as independent physicians want to stay independent,” he said.
“Make it friendly so we can increase quality, reduce costs, and remain in- dependent because we think that’s the best model.” n
Steve Levine is TMA’s vice president for commu- nications. You can reach him by phone at (800) 880-1300, ext. 1380, or (512) 370-1380; by fax at (512) 370-1629; or by email at steve.levine@tex
med.org.
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A TMA Group Discount Program Member 1.800.667.9723 September 2016 TEXAS MEDICINE 47
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