Overcoming the Challenges and Concerns of MACRA to Build a Path to Success

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program improves Medicare by helping focus on care quality and the one thing that matters most—making patients healthier. MACRA ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs. MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System (MIPS).

The Impacts of MACRA

Financial Impacts

MACRA’s will first impact payment in 2019, based on data submitted for the reporting year 2017. Medicare payment bonuses and penalties start at +/- 4% in 2019 and rise to 5%, 7%, and 9% each year until 2023. Eligible clinicians face the following outcomes in 2019 depending on what data they submit in 2017:

SUBMIT for 2017 Payment Adjustment in 2019
No data -4%
Minimum amount of data Neutral or small payment adjustment
Data that meets partial reporting requirements Small positive payment adjustment
Data that meets full reporting requirements Modest positive adjustment up to +4%

As you see in the table above, only some effort in 2017 can avoid a negative adjustment in 2019. However, this will change in future years. MIPS is implemented as a budget-neutral program, which means eligible clinicians’ payment adjustments are based on comparative performance with a Composite Performance Score. Post transition year, a negative adjustment may not be avoidable to clinicians with minimal participation.

Reputational Impacts

MIPS Composite Score and clinician performance rating will be published on CMS Physician Compare website. Patients or potential business partner will be able to see and compare the performance of a clinician. A positive MIPS score is likely to become an important factor in driving the success of a healthcare practice.

Are Providers Ready?

Even with the relaxed submission requirement for the first year, many providers are unprepared for the transition to MIPS. As reported by 2016 Deloitte physician survey of US Physicians, “Fifty percent say they have never heard of the law and 32 percent recognize it by name but are not familiar with its requirements.” Today, in the middle of 2017, low clinician awareness and poor preparation for MACRA has become a critical issue in replacing the older fee-for-service payment models with a value-based reimbursement program.

MACRA Challenges and Concerns

It is not a secret that adapting to changes in healthcare regulation has been particularly challenging for providers.

The length of MACRA final rule (over 2,000 pages) itself is enough to deter an average clinician from wanting to know anything about it. Unfortunately, this lack of knowledge creates confusion, anxiety, and frustrations. Providers’ main concerns about MACRA are:

  • Lack of expertise in developing strategies to achieve the highest performance scores.
  • Lack of sufficient knowledge in compiling metrics for regulatory reporting, especially when changes expected every year.
  • Lack of expertise in developing strategies to achieve the highest performance scores.
  • Lack of analytic skills to identify cause of performance weakness.
  • Lack of knowledge-based decision support for addressing performance improvements.

Getting Ready for MACRA: Practical Steps for Providers

Whether or not these challenges are significant, MACRA is coming and will create winners and losers. What can providers to get ready and, thus, be less likely to lose?

We recommend the following actions to prepare for MACRA:

  • Get a general orientation of the Quality Payment Program.
  • Get to know the minimal, partial and full MIPS reporting requirements for transition year.
  • Determine the quality measures relevant to your practice.
  • Consider joining medical societies and associations to share the financial and human resource on MIPS reporting and to achieve greater cooperation with other care organizations. You may wish to reach out to your professional society to learn about their plans to support MACRA reporting for their members. (For example, vendors like Prometheus work with specialty societies to develop Qualified Clinical Data Registries, or QCDRs, that help members comply.).
  • If you are responsible for an organization transitioning to MACRA, consult experts to create a set of optimized MACRA solutions for your stakeholders.

How Prometheus Can Help

Prometheus is a leading provider of clinical informatics solutions with software and expertise concentrating building Qualified Clinical Data Registries (QCDRs) to underpin healthcare quality initiative. We have produced a series of webinars and materials to help providers building an easy path to MACRA.

Services for specialty societies and ACOs

Provision of optimized MACRA solutions:

  • Helping to ease human resource burden on billing and quality reporting.
  • Supporting both individual EC reporting and GPRO reporting.
  • Testing reporting submission to ensure successful submission.
  • Reporting non-MIPS measures.
  • Providing real-time feedback on estimated performance score to submit the best performance measures.
  • Providing analytics report to support clinical research.
  • Providing knowledge based decision support for identifying gaps in care delivery and opportunities for interventions.

Additional learning resources: Education, Training, and Technical Assistance on MACRA from Prometheus

Prometheus has developed a webinar series that provides essential knowledge on MACRA, MIPS, QCDR and tips for successful registry reporting under the new Quality Payment Program.

You can access the 3-part webinar series on our RESOURCES page. Be sure to register to receive notification on new materials such as webinars, blogs, and whitepapers. Or, request a personalized consulting session with our registry and healthcare informatics experts.