We’ve been living in a MACRA world for some time now, and yet most physicians still aren’t ready—or even close to ready—for this new reality.
As if physicians weren’t already drowning in a sea of acronyms, The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 created the Quality Payment Program (QPP), which began measuring performance on Jan. 1, 2017. In 2019, payment rates will be adjusted under the QPP for physicians choosing one of two tracks: the Merit-Based Incentive Payments System (MIPS) or Alternative Payment Models (APMs).
Faced with government mandates, unfamiliar terminology, and a changing practice environment, many physicians are understandably feeling confused, anxious, and unprepared for MACRA’s quality reporting program. This program replaces the sustainable growth rate formula for calculating physician payments, as the healthcare system continues its transition from fee-for-service to value-based care.
However, the good news is that technology is adapting as the industry changes. A smarter clinical engine that enhances the usability of electronic health records (EHR) systems and integrates clinical quality measures at the point of care makes quality reporting relatively simple and painless for physicians.
Why many physicians are wary
First, though, let’s take a look at why MACRA is causing so much consternation among doctors. A recent KPMG-American Medical Association survey of 1,000 practicing physicians in the U.S. who have some awareness of MACRA and are involved in practice decision-making related to QPP, showed the following:
- Fewer than one in four physicians feel well-prepared to meet QPP requirements in 2017.
- Of respondents participating in MIPS in 2017, 90 percent feel MIPS requirements are slightly burdensome or very burdensome.
- Previous quality reporting experience is not enough. Only 25 percent of respondents with previous reporting experience, such as PQRS or meaningful use, feel well-prepared for QPP.
- Respondents indicated that the time required to report is the greatest challenge. Other major challenges include understanding reporting requirements, understanding the overall MIPS scoring process and the cost required to accurately capture and report data.
Survey after survey has found high levels of physician apprehension with MACRA and QPP. That’s not exactly a surprise, as physicians are rightfully concerned that a program they don’t fully understand could lead to financial peril or reputational damage. For example, a Black Book survey of 9,000 physicians recently found that 54 percent of respondents were unaware that the federal government will publish their quality data on CMS’ Physician Compare website, and that the data will be accessible by third-party rating systems, such as Yelp, Health Grades and Google.
Equally, if not more worrisome to physicians, are the financial penalties that they could face for failing to meet or report on QPP measures. Eligible clinicians who don’t reach the MIPS performance threshold could be due for some pain. Plans call for the redistribution of about $200 million in reimbursements from providers below the threshold to those who exceed it in 2019, the first payment year under the MACRA program. Ultimately, underperforming doctors could lose up to 9 percent of their Medicare payments, while high performers could see their payments boosted by as much as 9 percent.
For physicians – and in particular those who see a large amount of Medicare patients – the ability to properly document and report quality measures brings strong potential for greater financial reward. Likewise, failure to adequately document and report quality measures could lead to financial penalties, especially for physicians in small practices who lack the time and funding to fully understand MACRA’s implications.
As the survey results show, a substantial number of medical practice have not implemented the systems and processes needed to achieve MACRA compliance. While some doctors simply hope that MACRA will be repealed, the health system’s trajectory towards alternative payment models renders that prospect unlikely. Indeed, CMS has publicly stated its goal to tie 50 percent of all Medicare provider payments to value through alternative payment models by the end of 2018.
Technology As an Enabler – Not a Roadblock
Achieving financial success under MACRA is much more realistic when physicians employ the right point-of-care technology that makes it easy to perform, document and report on quality-improvement activities. Many systems do not integrate clinical quality measures at the point of care, and the result is that physicians often don’t realize which of these measures must be documented to obtain full reimbursement.
Instead of requiring physicians to remember exactly what they must document for every patient encounter to meet QPP requirements, point-of-care systems must automatically remind them as part of their established workflow. That’s why it’s critical that these systems are designed to emulate the way physicians work and think by following existing and well-established physician workflows.
Another challenge in MACRA compliance involves unstructured free text information that is captured and stored in EHR systems, but is not easily or accurately captured as coded data. Smart, next-generation point-of-care systems feature the ability to transform disorganized, complex arrays of medical information into structured, clinically relevant data, overcoming this problem and further enhancing EHR usability.
Understanding and fulfilling MACRA’s reporting requirements is certainly a challenge for time-pressed physicians who may feel frustrated and confused by the new regulations. But smarter point-of-care technology that mirrors the way physicians think and work can increase efficiency, help clinicians see more patients and guide them towards financial success in the world of MACRA.