According to a Deloitte survey, half of physicians are not even aware of this pending change. However, ready or not, CMS is poised to begin measuring physician performance on Jan. 1 for Medicare payment adjustments in 2019 under the Medicare Access and CHIP Reauthorization Act. This law, also known as MACRA, replaces the sustainable growth rate for physician payment adjustments under Medicare.
Here are five considerations for hospital-employed physicians as they prepare for MACRA, as presented by Linda Corley, vice president of compliance and quality assurance at Xtend Healthcare, during the Becker’s 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago.
1. While some details within MACRA — including the Jan. 1 start date — could still change because CMS has yet to issue a final rule, it is wise to prepare now. “I’m in favor of us keeping in mind Medicare is transforming us whether we want to be or not,” Ms. Corley said. She believes CMS will postpone MACRA measurements. But even if the law is delayed, change is still coming, she warned. SGR was a threat that never took effect, but she doesn’t see MACRA the same way. “You have to be ready at some point,” she said.
2. Lack of participation is not an option. The program is a bit different than those of the past because it’s not something physicians can simply elect out of, according to Ms. Corley. Unlike the physician fee schedule, where every physician in the country is paid based on scheduled dollar amounts, CMS is now asking physicians to participate in various reporting programs to maintain reimbursement levels. Those who elect not to report will incur penalties, she said.
3. Quality reporting will be essential. Ms. Corley conducted a small, informal survey of physicians at her hospital and found only two of the 35 polled knew what a Quality and Resource Use Report was and where to find it. “What does that tell us about our being prepared to undergo this change in reimbursement?” she asked.
The QRUR is a report that shows how physician Medicare payments will be adjusted based on quality and cost. It includes data from the Physician Quality Reporting System and helps determine a practice’s Value Based Payment Modifier. Because MACRA rolls together several existing programs — including PQRS and VBPM — accessing a QRUR now can help physician practices assess their readiness for MACRA.
“If your physicians haven’t been reporting data on quality measures, now is the time to start,” she said. Next year “is going to be the foundation for what your penalty or your value-based increase may be.” Physician performance in 2017 could add as much as a 12 percent boost or a 4 percent penalty in 2019 under the law’s Merit-based Incentive Payment System, one of the law’s two tracks. The other track, the Alternative Payment Model, requires physician participation in a value-based initiative such as an accountable care organization or bundled payment program. Because of this requirement, MIPS is expected to initially be the preferred track among providers.
4. Under MIPS, four performance categories will determine the composite performance score, which is used to determine payment adjustments. The four categories include quality, resource use, advancing care information (EHR use) and clinical practice improvement activities. Ms. Corley highlighted this last category because it is rarely done in physician practices. Clinicians will choose specific activities they want to improve based on their practice. “Some of this is going to be dependent on the physician determining what their strengths and weaknesses are, and whether or not we can set forth goals and say we are reaching those goals,” she said. The proposed rule includes more than 90 clinical practice improvement activities to choose from.
5. MACRA will pose IT challenges for many practices. This is another reason for providers to start educating themselves now on the law and its requirements. “One of our biggest unknowns is how we are technically electronically going to be able to reproduce the reports we need for this quality reporting, and will our partners understand and be able to build on our needs?” Ms. Corley said. Right now, she said there is no affirmative yes. “I had a very inflated idea of what EHRs could do for us,” she said. Getting the right clinical information out of EHRs that may be required for MACRA is highly contingent on how well the templates are built — something providers should begin to consider now.
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