It has been more than two years since Congress voted to enact the Medicare Access and CHIP Reauthorization Act of 2015 and subsequent deadlines for various aspects of the law were issued by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). And yet, surveys conducted earlier this year and a few conducted more recently indicate that a large number of healthcare professionals are not familiar with the Medicare Access and CHIP Reauthorization Act (MACRA).
What is MACRA?
MACRA authorizes HHS to implement value-based initiatives aimed at improving care access for Medicare and CHIP beneficiaries. MACRA made three important changes to how Medicare pays providers.
- MACRA repealed the Sustainable Growth Rate formula that determined Medicare payments for providers’ services.
- Participating providers are paid based on the quality and effectiveness of care provided.
- MACRA combines existing quality reporting programs into one new system.
Among the major provisions of the MACRA proposed rule, the most important one is the Quality Payment Program, which comprises of one of two paths for eligible clinicians: the Merit-based Incentive Payment System (MIPs) and Alternative Payment Models (APMs).
According to the survey conducted by Integra Connect, covering approximately 800 specialty physicians; most recognize that financial, clinical and operational changes are required to be successful under MACRA regulations. However, the majority of them have not yet invested in organizational, IT, or service improvements. The most critical finding of the survey – 100 percent of survey respondents indicated they have not yet fully grasped MACRA’s impact on their practices. While 71% of the respondents said that “I am learning but have a way to go,” 56% said that they were aiming for cost savings under MACRA through practice transformation to avoid unnecessary hospital stays and ER use. But, 24% of these were not prepared and around 40% are taking an approach limited to their existing resources and tools.
NueMD’s 2017 MACRA survey conducted from April to June 2017 and covering 1,052 healthcare professionals, found similar uncertainty with 50% of respondents claiming that they are “not at all” familiar with MACRA, 41% stating some degree of familiarity ad a mere 9% claiming to be “very familiar”. The answer most common to every question in the survey was “I’m not sure.”
Around 56% of the surveyed respondents did not know if they qualified for MACRA’s Quality Payment Program. Information about MACRA also seemed hard to find, according to the respondents, with 49% stating that they had not encountered any information on MACRA. Asked how they expected MACRA to impact their practice over the next three years, 63% respondents were not sure, 15% felt that it would have a negative effect and only 9% believed MACRA to positively impact their practice.
What the survey indicates
The findings indicate that while specialty practices do realize that MACRA presents a substantial clinical and financial opportunity, very few are well-positioned to realize optimal benefits, due to unpreparedness and limited investment in capabilities to manage attributed patient populations holistically and deliver both cost and quality improvements. The findings also indicate that the top three barriers to MIPS success include having the right people/skills (23 percent), understanding the requirements (20 percent), and cultural shift required to assume accountability for patients (19 percent).
While 62 percent of respondents either don’t know how, or have no plans, to fund these new upfront investments to enable MIPS success; 51 percent of respondents believe their current EMR is not prepared for value-based care, including APMs such as the Oncology Care Model, MIPS, and other bundled payment programs.
What should you do?
Data shows that an increasing number of specialty physicians are realizing that the transition to more holistic management of patients in support of MACRA will require fundamental changes. The problem is that few are taking the necessary actions to ensure success. To maximize clinical and financial returns under MACRA, practices will need a combination of comprehensive technology designed for their needs, process improvements and dramatic cultural change with new skill sets such as care management and navigation at the core. Outsourcing your requirements is one of the best ways to ensure that your practice is fully prepared to maximize the financial returns under MACRA. An efficient medical billing company can help ensure that your billing processes complies with MACRA guidelines, thus ensuring that your health care establishment continues to operate without any fear of penalties due to faulty billing mechanisms.
- Landi, H. (2017, August 28). Survey Finds Half of Healthcare Professionals “Not At All” Familiar with MACRA. Retrieved September 08, 2017, from www.healthcare-informatics.com: https://www.healthcare-informatics.com/news-item/value-based-care/survey-finds-half-healthcare-professionals-not-all-familiar-macra
- MACRA (Medicare Access and CHIP Reauthorization Act of 2015). (2017). Retrieved September 08, 2017, from www.searchhealthit.techtarget.com: http://searchhealthit.techtarget.com/definition/MACRA-Medicare-Access-and-CHIP-Reauthorization-Act-of-2015
- MACRA. (2017). Retrieved September 08, 2017, from www.cms.gov: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
- Specialty Practices Unprepared for MACRA Requirements, According to Integra Connect Data. (2017, September 06). Retrieved September 08, 2017, from www.markets.businessinsider.com: http://markets.businessinsider.com/news/stocks/Specialty-Practices-Unprepared-for-MACRA-Requirements-According-to-Integra-Connect-Data-1002345614