MACRA is coming.
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law on April 16, 2015. It’s a pay-for-performance program that focuses on quality, value, and accountability by rewarding healthcare providers for improving their patient’s overall health. Health and Human Services has stated that its goal is to tie 90 percent of all Medicare fee-for-service to quality or value by 2018.
However, recent Centers for Medicare & Medicaid Services (CMS) changes to bundled payment programs and the newly released 2018 proposed rule for the MACRA, which eases requirements for rural and smaller physician groups, has left many healthcare providers feeling confused about the direction of the industry.
According to Saqib Akhter, CEO of Post-Acute Analytics, a company that helps health systems and providers monitor their patients in real time outside their four walls, MACRA is on pace and there is no reason to be uncertain about the future of healthcare.
“In our view, while there are short-term fluctuations and conversations on types of programs and their exact details, the overall direction of the healthcare industry is clear,” said Akhter. “Very soon, almost all of the care delivered for Medicare patients is going to be tied to some metric. These changes are being driven by overarching economics, because Medicare is on-track to be out of funding by 2029.
“However, CMS is also trying to respond to the concerns of the industry. It’s clear that many physicians feel the reporting requirements are going to be difficult to manage. The reporting requires tracking metrics that providers have not historically monitored. There are new sets of measures, and it’s a pretty heavy list.”
According to a recent American Medical Association survey, 90 percent of the physicians polled view the reporting requirements as either “somewhat” or “very” burdensome. And fewer than one in four physicians believe they’re “well-prepared” to meet requirements of the Quality Payment Program.
Perhaps more concerning, 51 percent of the polled physicians feel they’re somewhat knowledgeable about MACRA’s rules while only eight percent believe they’re “deeply knowledgeable” about the program.
If you’re concerned about the reporting requirements of MACRA, click here to sign up for a discussion and demo on how Post-Acute Analytics can help.
The pace of MACRA is such that it is likely the push for reporting on cost and quality measures and to enlist physicians in Advanced Payment Models (AMPs) will increase over the next few years. Fortunately, there are steps physicians can take to prepare for and achieve the requirements of MACRA.
How concerned physicians can become more comfortable with MACRA
“In order to meet the requirements of MACRA, providers need to find a technology partner that can tap into a practice’s existing workflow without any interruptions. Providers are extremely busy, so it’s important that any new systems do not impede their ability to see more patients,” said Akhter.
“This technology partner will give practices a picture of how they are performing relative to the MACRA metrics, so they can discover where they are doing well, where they need to make improvements, and which metrics to choose. During this process, the partner will likely uncover MACRA requirements that the practice is currently not able to track. The technology partner will be able to work with the practice to seamlessly develop new workflows and ensure every metric is being met.”
One thing that providers must be aware of is that their performance scores will be available to the public. This is the first time potential patients will be able to compare physicians with a simple, standardized measure.
“With MACRA, physicians have to choose one of two paths,” said Akhter. “They can go down the Merit-Based Incentive Payment System (MIPS) path, which are the reporting requirements that will generate these performance scores, or they can focus on Advanced Payment Models, which avoids the reporting requirements because physicians are taking a direct risk on the total cost of care.
“However, even with MIPS total cost of care is going to be a large component of the overall rate reimbursement. So, focusing on total cost of care while improving patient outcomes is advantageous to physicians regardless of their focus.”
Physicians and hospitals are going to need to work closely with other organizations, such as post-acute providers, to exchange data and track a patient’s overall progress. A major focus of MACRA is for providers to manage a patient’s health across the entire continuum of care, not just a single episode.
“About 50 percent of Medicare patients go from a hospital to a post-acute-care setting,” said Akhter. “There are a number of measures within MIPS that track transition of care, post-discharge follow up, and total cost of care. Examples of these are medication reconciliation post-discharge, unplanned reoperation within the 30-day postoperative period, and Medicare spending per beneficiary. Providers are going to need a platform that automatically tracks these metrics and, if any of them are not met, alerts providers in real time so they can proactively take corrective action and avoid negative quality and financial outcomes.”
It’s Never Too Early to Prepare
The ultimate goal of MACRA is to improve overall patient health and to reward the practices that succeed in doing so while maintaining or lowering costs.
“The quality of care is not up for compromise,” said Akhter. “Providers are looking to achieve the best outcome for the patient, period. So, the question becomes, ‘What costs are appropriate to achieve that best patient outcome?’ Essentially, if a patient needs three things to achieve the best outcome, don’t add a fourth. That’s what we mean by appropriate costs. Utilizing technology that provides real-time information on a patient’s progress, such as when they have plateaued, when there are early signs of them getting worse, so those can be acted on proactively is essential to provide the best outcome for the patient while capturing every possible revenue opportunity.”