The Road to MACRA Success Does Not End With MIPS

It is important to recognize that the road to long-term success does not end with the implementation of the Merit-based Incentive Payment System (MIPS). In CMS’ own words, MACRA’s final rule was established, in part, to incentivize and promote participation in Advanced Alternative Payment Models (APMs). These incentives include a 5% participation bonus from 2019 to 2024 and a 0.5% annual increase above the MIPS track beginning in 2026.

In addition to the financial incentives under MACRA’s APM track, eligible clinicians have the opportunity to share in the financial upside of participating in a successful APM. Beyond these incentives, there are several other key financial considerations when determining a long-term strategy for APM participation:

Investment in Infrastructure

Additional reporting requirements for tracking quality, costs, and population metrics will require increased investment in IT, training, consulting, and additional support staff.

These costs, which should be considered in any long-term MACRA strategy, have frequently been cited as the reasons for consolidation activity in the market given the financial strain on solo practices created by MACRA.

There are also positive factors that providers miss when focusing solely on these costs. Properly used data analytics can help identify cost outliers and quality performance opportunities that may lead to improved patient care and market share.

Clinical Efficiencies

While MACRA has financial incentives for quality improvement and, beginning in 2018, cost and resource use, there are also potential cost savings that arise from clinical efficiencies.

Strategic investments in IT and care management infrastructure can lead to enhanced clinical capabilities for practices by providing a more integrated view of each patient’s care continuum and identifying costly variations in patient care.

Providers and practices that are able to eliminate costly variations stand to improve the bottom line through lower costs of care. These potential savings are magnified for health systems able to reduce readmission rates and average length of stay due to physician quality and efficiencies.

Market Share

Growth in market share is one of the greatest potentials for a physician practice looking to improve financial results.

Publicly available Quality Payment Program (QPP) scores and improvements in consumer-focused healthcare delivery models create opportunities for healthcare marketing and patient panel growth. Because increased patient volume results in higher marginal returns, this becomes a viable opportunity for practices not already operating at capacity.

Private Payer Contracts

If history is any indicator of future reimbursement changes, private payers will follow CMS’ lead with the QPP. Commercial payers in numerous markets created accountable care organization (ACO) shared savings arrangements, bundled payment initiatives, and other pay-for-performance programs that pre-date MACRA.

By positioning a practice for MACRA success, eligible clinicians are better prepared to capitalize on future commercial value-based contracts. Of particular note, participation in commercial APMs may help clinicians qualify for APM bonuses beginning in 2021.

Consider This

Consider other factors specific to each practice and market in a long-term strategy. When participating in an ACO, consider resource utilization and its related impact on participating provider distributions. Practice leaders should not lose sight of these broader strategic considerations.

Establish a long-term MACRA solution by looking beyond MIPS. 


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Topics: Payment Models, MIPS Healthcare, MACRA Summary

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