MACRA: Are You Ready?

Wait-and-see is no longer a viable strategy for payment reform—especially with regard to MACRA implementation.

In my 30 years serving healthcare practices, I have seen innovations come and go. I certainly understand the impulse to sit back and let the dust settle before rushing to implement a new regulation, and the steady Republican drumbeat of “repeal and replace” is enough to give any provider pause.

But know this: the evolution of payment models from volume to value has decades of momentum behind it. With strong bipartisan support, MACRA is the vehicle by which CMS is incentivizing physicians to deliver better quality care at lower costs. While Congress and CMS might tweak the implementation timelines or other details, MACRA is here to stay.

Yet physicians, by and large, still have limited awareness of this sweeping payment reform. A September 2016 survey by The Physicians Foundation found that out of more than 17,000 physicians, only 5.9% were “very familiar” with MACRA and 14% were “somewhat familiar.” One-third of respondents were “very unfamiliar” with the law. Even those health systems and practices that are familiar with the law struggle with a lack of technological and human resources to comply with its requirements.

Getting Ready for MACRA

But there’s no going back to the days of unchecked growth in healthcare costs. Delivering higher quality care at lower costs to a healthier population is simply a better business model.

So here’s your choice: Join the march, or be left behind. The following steps are a good place to start, if your health system or medical practice hasn’t already taken them:

  • Get your arms around your data. First, understand what data your practice already is reporting to CMS for programs such as the Physician Quality Reporting System and the Physician Value-Based Payment Modifier. Then visit the Quality Payment Program website to understand the categories and specific measures you have the option to report.
  • Evaluate technology platforms. What is your organization’s capability to extract the data from your internal systems and report it to CMS? Many of the Quality Payment Program measures are new, so gathering them will likely take some digging and manipulation. Note: You’ll want to verify that your electronic health record system is certified by Office of the National Coordinator for Health Information Technology.
  • Make choices based on your own data. MACRA was designed to give clinicians flexibility in how they are measured and how quickly they are held accountable for those measures. From the choice of the track in which you will participate (MIPS vs. APM) to the specific quality measures you will report to whether you will report as individual physicians or a group practice—all of these choices will have both short- and long-term impact. Perform a financial impact analysis to understand that impact at the physician level and the organization level. We sometimes get the question, “What if we refuse to participate?” Organizations and physicians that don’t submit any 2017 data will receive a sizeable 4% payment adjustment in 2019—and that payment adjustment cuts directly into physician compensation. Because practices still must carry all of their operational expenses, that 4% top-line hit translates to an even bigger dent in the physicians’ pocketbooks.
  • Engage physicians. The hard truth is that there will be winners and losers in this system. Because MACRA is designed to be budget neutral, many clinicians and their practices will see their bottom lines shrink. The individuals and organizations that will come out ahead are those who understand the new rules of engagement and are prepared to make the requisite changes. Physicians and other clinicians are essential in this endeavor, because they are the ones who can change how care is delivered. No value-based incentive program will succeed without provider support. Take time now to educate physicians and other providers about these new rules and the invaluable role they play in implementing a winning strategy.

These steps are not sequential; the most successful organizations are pushing forward aggressively on all of these fronts. At the same time, don’t let the complexity of MACRA implementation overwhelm you and stop you in your tracks. Lean on your advisors and technology vendors for support in each of these areas. We also recommend naming a champion within your organization to act as a resource, model desired behavior, and support critical infrastructure investments.

Most importantly, don’t sit back and wait. All payers are moving toward the Triple Aim, and MACRA represents a true opportunity to advance your organization toward the goal of better care for individuals, better health of populations, and lower costs for our healthcare system.


I want weekly insights into Payment Model Reform:

Subscribe to the Healthcare Blog

Topics: MACRA Summary

Leave A Comment

Related Posts