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Health Plans: Tell Your Doctors: MACRA Is Here.

January 18, 2017
Many sources reveal that provider communities are unaware and unprepared for MACRA.
President and CEO

The first measurement year is upon us. Unfortunately, too many sources reveal that your provider communities are unaware and unprepared for MACRA (Medicare Access and CHIP Reauthorization Act of 2015). While the Centers for Medicare and Medicaid Services (CMS) have provided a degree of flexibility for 2017, letting this year slip by will be a grave misstep.

Survey Says

According to the 2016 Survey of American Physicians, a mere 20 percent of physicians are “somewhat” or “very” familiar with MACRA -- the vast majority of physicians across practice type, age, gender and employment type are unaware or neutral at best:

Opt 2 MACRA physician chart

The Deloitte Center for Health Solutions 2016 Survey of US Physicians found:

  • 50 percent of physicians have never heard of MACRA
  • 32 percent recognize the name, but are unfamiliar with it
  • 21 percent of independent physician have heard of MACRA, but are only “somewhat” familiar with it
  • 9 percent of employed physicians have heard of MACRA

Outreach Now

We hear from all our health plan clients that strengthening provider relationships is a top priority. Here’s a good opportunity to take one of the many small actions that further this objective.

Small actions big changesWhether or not you have a shared communication platform with your providers, you must reach out to help ensure they are aware of MACRA and that they are taking the necessary steps to avoid penalties.

There are many things you can and should be doing on a grander scale to prepare your organization for the sweeping changes ahead. This one outreach alone is not enough, but it’s something.

We understand that you are busy, so we wrote a sample email message that you can share with your provider community. It’s free. You’re welcome.

Subject: Protect Your Medicare Reimbursements

Importance: High

Dear Providers,

CMS has changed the way you will be reimbursed for your Medicare populations. Right now – 2017 – is the first measurement year and will impact your 2019 reimbursement rates (by as much as -4 percent).

This change is a result of MACRA – the Medicare Access and CHIP Reauthorization Act of 2015.

Your options for this year are flexible, but only for this year.

Options are:

  1. Do nothing. Eligible providers who do nothing will receive a negative 4 percent adjustment to their 2019 Medicare reimbursement rates.
  2. Do something. Anything. Just don’t ignore MACRA and hope it will go away. Reporting on a single measure will prevent the 4 percent negative adjustment and indicate you are ready to participate in the first full reporting year (2018).
  3. Do a little bit. Collecting performance data for any single 90-day period between Jan. 1, 2017 and Oct. 2, 2017 will qualify clinicians for a neutral or small upward adjustment.
  4. Do it all. Collecting a full year of performance data will qualify clinicians for a moderate upward adjustment.

If you participate in an approved alternative payment model: a 5 percent bonus payment will be earned by clinicians receiving 25 percent of their Medicare payments and seeing 20 percent of their Medicare patients through an advanced APM.

Read more about MACRA’s quality payment program here.


Don’t delay. Please reach out to us for additional resources.