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Greg Anderson

Health Care

Seven Steps to Take Now to Get Ahead With MACRA

Timeless strategies for current regulations

Published: Tuesday, February 7, 2017 - 13:02

Like it or not, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is here. MACRA created the new Quality Payment Program, comprised of two pathways to higher quality: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (Advanced APMs). MACRA changed the rules, leaving many to face an uncertain future. Amid the uncertainty, however, one thing is sure: passivity will be costly. Indecision will not prevent or delay physicians’ placement into the quality and efficiency compensation measurements of MIPS.

Those who have prepared for delivery and payment model reforms can actually reap rewards for their efforts; it’s not too late for those who haven’t. How does a successful strategy look? While specifics differ, those in a better position for favorable outcomes have taken the following seven steps that have become the common denominator among providers:

1. Educate key stakeholders. The better-prepared organizations have made training of providers, executives, and practice managers a top priority. As we reported earlier, physicians are largely unfamiliar with MACRA. High-performing practices and facilities involve key clinicians. Do your providers know about MACRA and its implications?

2. Name a physician champion. Physicians who embrace delivery and payment model reforms are poised to drive change. What qualities do these clinical leaders have in common? They are committed, passionate, and able to influence other clinicians and facilitate changes. Value-based incentive programs will fail without provider support, and key leaders must help build communication, trust, and transparency. The real champions understand and are able to engage physicians in behavior changes, support critical investments, and preserve viability.

3. Know where your organization stands today and where gaps exist. Organizations ready for MACRA have participated in the Physician Quality Reporting System  and attested to Meaningful Use. These organizations understand by evaluating historical performance how they will fare. They have the ability to assess quality, improvement activities, advancing care information, and cost performance, and make decisions about the most relevant and profitable measures. Have you taken a snapshot of your recent past performance and conducted a gap analysis to identify areas for improvement in data capture, performance, and reporting?

4. Know your electronic health record vendor better. Not all electronic health record systems support data collection and reporting on all MIPS measures. Find out which measures are supported. An estimated 90 percent or more of the administrative burden of MIPS can be assumed by the health IT vendor, which could later become your application performance monitoring data partner, so solidify that relationship now.

5. Decide how best to report. Pick your pace. The transitional performance period for MIPS began Jan. 1, 2017, so determine now which measures to report among those that are most relevant and have the greatest potential impact. Choose when to begin reporting and whether to report clinicians individually or as a group under a common tax identification number. Decide how to report, whether through the content management system web interface or third-party services, such as a certified electronic health record, registry, or a qualified clinical data registry.

6. Align clinicians’ incentives. Clinicians care about patients and are committed to serving patients’ best interests with high-quality care. Providers should recognize MACRA changes as opportunities to improve care and lower costs by using evidence-based measures. Do you use dashboard reporting of clinical quality measures? Has your incentive compensation plan undergone a transformation to reward those providing the highest quality of care?

7. Create an aternative payment model strategy. Evaluate your organization’s current APM involvement. Those who can reap the biggest gains are successful in Advanced APMs. CMS is providing opportunities for clinicians by retrofitting existing models and creating new models that qualify as Advanced APMs, including the new ACO Track 1+ model, a new Advanced APM for 2018. Consider this and others, such as CPC+ and Track 2, Track 3, and NextGen accountable care organizations.

Unanswered questions exist for many organizations and providers, but this doesn’t mean putting off important decisions and delaying efforts to improve clinical quality and investigate inefficiencies. Seek the counsel of your clinicians and financial, legal, and operations staff and advisors, and remember this is not a one-and-done exercise—the Quality Payment Program will evolve with time.

Get ahead now to improve your chances of staying ahead.


About The Author

Greg Anderson’s picture

Greg Anderson

Greg Anderson is a partner in the healthcare practice group of HORNE LLP and concentrates his consulting on income distribution plans for physician group practices; design, implementation and fair market value studies related to hospital/physician employment and other compensation arrangements; and the valuation of medical practices, hospitals, diagnostic facilities, ambulatory surgery centers and other health care facilities. Anderson is a graduate of the University of Southern Mississippi. He is a certified public accountant accredited in business valuation and a certified valuation analyst.