Medicare Access and CHIP Reauthorization Act in Small to Medium-Sized Primary Care Practices

J Am Board Fam Med. 2020 Nov-Dec;33(6):942-952. doi: 10.3122/jabfm.2020.06.200142.


Background: 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 ( perceive their quality incentives under MACRA.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Accountable Care Organizations; Focus-Groups; Interdisciplinary Research; Medicare; Ownership; Pay for Performance; Primary Care; Quality Improvement; Virginia.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accountable Care Organizations*
  • Aged
  • Humans
  • Medicare
  • Physicians*
  • Primary Health Care
  • United States
  • Virginia