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    Off the fee-for-service hamster wheel

    Policy leaders welcome shift to value-based care

    Alan L. Kaplan, MDAlan L. Kaplan, MD

    Dr. Kaplan is a urologist and fellow in Healthcare Strategy and Leadership at UCLA Health, Los Angeles.


    Although much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), its implications for the practicing urologist remain uncertain. Despite the Oct. 14, 2016 policy finalization of the law, many practitioners show a fundamental lack of understanding and awareness of it. A Deloitte survey of over 500 physicians conducted in April and early May 2016 indicated some pretty stark statistics about how unfamiliar many doctors are with MACRA. Half of the respondents had never heard of the law and 32% only recognized the legislation by name.

    Related: MACRA implementation emphasizes specialty collaboration

    Gary M. Kirsh, MDDr. KirshFollowing the 2010 passage of the Affordable Care Act (ACA), much was written about accountable care organizations (ACOs), but direct relevance to urologists was scarce. MACRA, on the other hand, more directly affects the urologic book of business. To gain a better appreciation of how that impact might play out in the coming years, I spoke with some leading urologists with expertise in payment reform and value-based care for their perspective.

    For outgoing LUGPA President Gary M. Kirsh, MD, the passage of MACRA is a welcome ushering out of fee-for-service medicine. “Fee for service is ultimately not in our interest; we can’t run any faster on the fee-for-service ‘hamster wheel,’ and it’s limiting our creativity and entrepreneurship,” Dr. Kirsh said.

    “We’ve been waiting for this with bated breath,” said urologist Deepak A. Kapoor, MD, CEO of Integrated Medical Professionals in New York. The ACA, Dr. Kapoor said, “mostly focused on process rather than outcome measures. The regulatory burden fueled hospital acquisition of physician practices, driving up health care costs by shifting care to the least efficient and most expensive site of service. Fast forward to MACRA and [the changes envisioned by ACA] are codified into statute for CMS to implement.”

    Neal Shore, MD, director of the Carolina Urologic Research Center in Myrtle Beach, is a proponent of urology groups “embracing the changes… as we shift from volume to value. I think those taking the reactive rather than proactive approach are making a mistake.”

    Also see - MACRA: How changes in final rule affect urology

    Alec Koo, MDDr. KooAlec Koo, MD, managing partner of Skyline Urology in Southern California, shares Dr. Shore’s sense of opportunity. “Docs are fearing [MACRA] but really should be celebrating this as a tremendous opportunity. We all know there’s a lot of inefficiency in clinical care. When we start risk and gain sharing, then we have skin in the game to truly move the needle and improve,” Dr. Koo said.


    Next: APMs vs. MIPS


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