Hartford Business Journal

www.HartfordBusiness.com August 15, 2016 • Hartford Business Journal 9 Quality Construction + Butler Manufacturing = Repeat Customers www.borghesibuilding.com © 2011 BlueScope Buildings North America, Inc. All rights reserved. Butler Manufacturing™ is a division of BlueScope Buildings North America, Inc. 2155 East Main Street • Torrington, Connecticut 06790 Goodwill Brookfield | 2007 | 13,050 sq. ft. Goodwill Westport 2011 | 9,960 sq. ft. Goodwill Torrington 2002 | 14,690 sq. ft. Contact us at 1-855-BUILD-86 or visit us on the web. But APMs also can carry more downside risk if patient costs exceed certain thresholds and doctors have to eat the costs. The alphabet soup is enough to boggle the mind, let alone the rules behind the letters. "I think that MACRA could in the long run help to improve the quality not only of care pro- vided, but the health and well being of Medi- care beneficiaries in Connecticut, but it also has the potential to be the downfall of medi- cal practice in Connecticut if it's done wrong," Katz said. That's a concern of most Connecticut doc- tors interviewed for this story. "I would say that it's going to have a very negative impact on many small practices in Connecticut," said Dr. Timothy Chartier, a Mohs micrographic surgeon and partner in Dermatol- ogy Surgical Associates LLC, which has offices in Farmington and Glastonbury. Most physicians would agree with the con- cept of MACRA, the idea of which is to lower the cost of medicine while improving it, he said. "I think that's where the rub is — that a lot of the measures they're instituting on practices are complex, they don't really have any real mean- ing to individual physician practices," he said. Many measures required under MACRA don't apply to his area of practice and do little to improve patient care, he said. "It's just going to increase my staffing over- head, it's going to detract me from doing what I primarily do for my patients and it's going to result in longer wait times for patients because now I'm getting slowed down basically to mea- sure things that really have very little impact in the care of my patients," Chartier said. Physicians practice evidence-based medi- cine, but many of the new regulations have no evidence they improve care, he said. So what's the answer? "Continuing to work on the concepts behind MACRA … and that they're rolled out in a way that's not punitive to practices," Chartier said. Jeff Gordon, a hematology oncologist who practices with two other doctors in the New London Cancer Center in Waterford, said doc- tors could help make MACRA better and he hopes it can be delayed to allow that. "My opinion is that if there are no changes made with it and it's not slowed down to really try to make it a more effective program and a more user-friendly program for patients and for physicians, it's doomed to failure," said Gordon, incoming president of the state medical society. Small groups in peril Dr. Courtland Lewis, an orthopedic surgeon in the Hartford HealthCare Bone & Joint Insti- tute at Hartford Hospital, is already operating under an APM through a bundled-payment pro- gram. While his group has made significant cost improvements to patients' overall care, specifical- ly post-discharge as more patients rehab at home instead of inpatient rehabilitation facilities, the group hired two nurses to help patients navigate from presurgery through 90 days postsurgery. However, the group still is not able to hit Medi- care price targets, meaning it's costing more to manage the program than the group is get- ting back through it and it won't get any easier under MACRA as price targets adjust, Lewis said. Lewis thinks the answer is to pilot alternative-payment models until there's a high level of confi- dence they'll work in the real world across different geographies and patient populations. He also fears MACRA's impact on solo and small practices. The logistics of participating in such programs are substantial, he said. "It takes resources, it takes people," Lewis said. "If you're in a big practice like I am, even though it's single-specialty practice, you've got a prayer of a chance because we've got some folks whose job it is to help us collect the information." Deloitte's Thomas said MACRA is hap- pening, although it's possible some parts could be delayed. Additionally, health plans may want to align their quality-measurement strategies and value-based care strategies with MACRA, she said. "So I think there's some implications for health plans and for providers and frankly even for some of our life sciences companies because they're going to need to think about what this is going to mean for them — so the whole industry is interested in this law," she said. n Medicaid Reimbursement Jeff Gordon, hematology oncologist, New London Cancer Center Dr. Courtland Lewis, orthopedic surgeon, Hartford HealthCare Bone & Joint Institute, Hartford Hospital ▶ ▶ ' I think that MACRA could in the long run help to improve the quality not only of care provided, but the health and well being of Medicare beneficiaries in Connecticut, but it also has the potential to be the downfall of medical practice in Connecticut if it's done wrong.' Matthew Katz, CEO and executive vice president, Connecticut State Medical Society Subscribe online: HartfordBusiness.com/ subscribe Delivering Business. When you need information to grow your business, we deliver! Subscribe today to receive weekly issues in print and digital, plus special publications and full online access!

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