MACRA: New Rule Debrief
Analysis of changes to MACRA measurement year 2018
April 06, 2017
Heather Lavoie, Chief Strategy Officer
Citing a lack of financial resources, technology and qualified health IT support, 64 percent of healthcare professionals say their organizations are still not ready for MACRA (Medicare Access and CHIP Reauthorization Act) reporting. The Stoltenberg survey, conducted during the recent HIMSS (Healthcare Information Management Systems Society) conference in Orlando, polled healthcare professionals spanning IT, executive/C-suite, practice management and project management roles.
Specifically, 68 percent of respondents agree MACRA reporting requires aligned effort by clinical, financial and IT departments. However, 58 percent claim their IT department is understaffed and finding experienced, qualified candidates is “difficult” (54 percent) to “very difficult” (28 percent). Given the IT-intensive support required to execute new quality reporting, it is not surprising to hear 31 percent claim “revising data management/reporting mechanisms” is their biggest hurdle, followed closely (29 percent) with motivating departments to work together.
In the end, this lack of technology, alignment and knowledge leaves 64 percent of healthcare organizations “unprepared” or “very unprepared” for MACRA reporting.
MACRA represents the next evolution in value-based healthcare. The sweeping changes enacted through MACRA fundamentally change the way the Centers for Medicare and Medicaid Services (CMS) reimburse for the care of its Medicare population.
It is distressing to realize how few healthcare professionals are prepared for MACRA reporting. As we enter the second quarter of the first reporting year, the reality is many are still unprepared, and there are only a few months left. After Oct. 2, 2017, it will be too late to start collecting performance data. Substantial negative penalties await those who miss the deadline (along with missing the opportunity to earn bonuses).
How could this happen, particularly when those affected face a four to 10 percent reduction (or potential bonus) in revenue?
Let’s circle back to the reasons uncovered in the survey – insufficient resources in the form of budget, expertise and technology coupled with a lack of cross-functional alignment. It seems obvious to me that this is an opportunity for health plans to lead, create new accountable care arrangements and strengthen provider relationships through sharing data, technology and knowledge with their provider network.
The depth of knowledge and sophistication of technology contained within health plans far surpass that of any other type of healthcare organization. Comparatively, providers are relative newcomers to healthcare analytics and quality reporting – at least for those outside of existing alternative payment models (which is the vast majority).
For example, the Quality Payment Program (QPP) of MACRA replaces the Physician Quality Reporting System (PQRS). While several reporting options existed for the latter, most physicians relied on passive, claims-based reporting. Additionally, many physicians ignored PQRS and simply absorbed the penalties (which topped out at negative two percent).
The QPP changes all that. MACRA penalties start at negative four percent and quickly climb to negative 10 percent. Physicians must take an active role in gathering, cleansing, authenticating and
reporting Medicare data. Managing data is second nature for health plans, not so much for most physicians. The lack of MACRA readiness portends unfortunate outcomes for physicians.
Health plans know negative outcomes to providers will eventually flow their way. By sharing resources and technology now, health plans can avoid potential cost-shifting measures. Forward-thinking health plans recognize the opportunity and embrace the challenge in a strategic and realistic way to help their provider networks understand and navigate the impending MACRA reporting requirements while fostering a competitive advantage.
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