New payment models: Decide a practice setting

You are a member of a six-person family medicine practice in a city with a population of one million people in the Midwest. Your practice is very busy, with most commercial patients coming from three major insurance payers in the city. About 60 percent of your practice is commercial and the remainder is largely Medicare. You have very little negotiating leverage with the insurance companies, and as a consequence, your reimbursement has been consistently declining in the last years. Recently, you did receive an increase in commercial payment rates, but it has not resulted in a significant improvement in your practice revenue. However, you are concerned that the changes in Medicare reimbursement required by the MACRA legislation will result in reductions in Medicare reimbursement and increased regulatory costs. Nevertheless, on the whole, it is a comfortable practice with adequate income at present, but you are concerned about the future.