The MACRA marathon: 3 keys on training for success

Success under the Medicare Access and CHIP Reauthorization Act's Quality Payment Program is all about the long game — it will require conscious, continuous investment.

"MACRA, or the QPP, is very much like training for a marathon," Caleb Manscill, vice president of product and marketing at nThrive, said while moderating a webinar hosted by Becker's Hospital Review. nThrive is a revenue cycle management company."You can't simply wish to do well under this initiative, especially considering the competitive nature of it. It's something you need to invest in if you really want to do well and see the financial and quality returns on your investment."

For physicians, the time to start educating is now. MACRA is the law that replaces the sustainable growth rate formula to determine Medicare payment adjustments for physicians. MACRA establishes the QPP, which has two tracks — the Merit-based Incentive Payment System and the Advanced Alternative Payment Model. CMS spent most of 2016 fine-tuning the programs, issuing a final 2,400-page rule at the end of October. And though the QPP is based on familiar CMS programs — like meaningful use, the Physician Quality Reporting System and the Value-based Payment Modifier — there's a whole new rulebook, and the game has already started. Jan. 1 marked the beginning of the first performance year, which will determine payment adjustments in 2019.

Mr. Manscill was joined on the webinar by Moshe Starkman, senior value-based reimbursement consultant at nThrive, and physician informaticist Michael Marron-Stearns, MD. Together, they offered providers the following three keys to MACRA success.

1. Strategic planning.
Dr. Marron-Stearns and Mr. Starkman advised organizations to begin by taking an honest look at their current state and their end goal to help craft a plan. Hospital leaders should ask themselves, "How risk-averse are you? How risk-confident are you?" said Dr. Marron-Stearns. The aim of the program is to ultimately push clinicians into taking on downside risk in value-based care programs, many of which will fall under the advanced APM track.

Physicians in advanced APMs are exempt from MIPS reporting requirements, but for most physicians the advanced APM track is still far off. Mr. Starkman estimates 90 percent of eligible clinicians will report under the MIPS track during the 2017 transition year, which means they must be ready to understand reporting requirements. Luckily, CMS is allowing providers to pick their pace in 2017 as they adjust to the new program. This means providers can avoid negative payment adjustments in 2019 by submitting one quality measure. They do have the potential to earn much more than just a neutral payment, however, by submitting at least 90 days of 2017 data or submitting a full calendar year of data.

To begin planning processes for 2018, when providers must report 365 days of data, Mr. Starkman and Dr. Marron-Stearns advised taking the partial option and submitting 90 days-worth of data to CMS. They also recommend measuring more than six quality measures since Medicare will take providers' top six scores. Plus, the program compares scores nationally, so providers may have done "well" on a certain measure in the past, but not so well compared to the national average.

"Go ahead and dive in as quickly as you can. Do some practice runs. See where the problems are and then define your reporting period and make it at least 90 days," Dr. Marron-Stearns said.

2. Meaningful, ongoing education.
"Any time you have a significant regulatory change in healthcare, education is the center of success," Mr. Starkman said. "If you don't understand what is being asked of you or why it's necessary, there will be reluctance and you will have lower adoption rates."

Education for MACRA should be tailored, accessible and continuous. The programs affect staff across clinical, financial and IT departments, but their concerns and focus will be different across each department. Education efforts should reflect that. "You have to really target the training toward different individuals," Dr. Marron-Stearns said. "You don't want to drain peoples' time." He also suggests providing educational tools that are user-friendly and easily accessible, such as an e-learning course staff can pull up on an iPad at their convenience.

Mr. Starkman noted that the education — just like marathon training — should be ongoing. Not only is MACRA legislation incredibly complex, but it is still evolving as CMS reviews and optimizes it in its initial years. "This is a marathon," Mr. Starkman said. "Stay on top of continuing education and recognize the various levels of education, and at the same time, the various mediums through which people learn."

3. Optimized technology.
Lastly, because success under MACRA requires careful tracking, reporting and improvement, meaningful data is critical. "Within MIPS — in this new world, competitive environment — it's not enough to know where you are, you have to know where your competitor is," said Mr. Starkman. Providers need to perform above the national average to avoid a penalty, so tracking data is essential.

The key right now for organizations is to combine various data repositories and map them into a single system. This is the "holy grail" of data, according to Mr. Starkman. Having a single, integrated view is crucial because it can help organizations see the big picture, pinpoint problem areas and report the most meaningful, actionable information for individuals within the healthcare system.

nThrive offers MIPS reporting services, performance assessments and other solutions to help clinicians achieve success in MACRA and other value-based care arrangements.

For more specifics on MIPS, advanced APMs and their associated challenges, risks and rewards, listen to the full webinar recording here and view the slides here.



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