Over the past several years, healthcare organizations have been tasked with taking on more and more regulatory standards. The Medicare Access and CHIP Reauthorization Act (MACRA) is just one of the many regulations that the industry is still trying to adjust to. A recent survey found that 64 percent of respondents from provider organizations reported being either unprepared or very unprepared for managing and executing MACRA initiatives. So what exactly is MACRA?
As explained by the American Academy of Family Physicians, MACRA “creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment.” The main value of MACRA is to continue all the huge strides organizations have made through Meaningful Use, and to help them provide the highest quality care at the best possible value.
The two MACRA tracks are the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (Advanced APMs). With MIPS, Medicare is consolidating and will expand upon all three previously existing programs and add a fourth. The categories of MIPS that organizations will be scored on are Quality, Resource Use, Advancing Care Information, and Clinical Practice Improvement Activities.
While most physicians will likely move through the MIPS track, some will receive payments through a qualified Advanced APM. Advanced APMs are pre-defined by CMS and incentivize quality, use a certified EHR, and bear more than a nominal financial risk.
To get an executive’s take on MACRA, I sat down with our Executive Vice President, Hoda Sayed-Friel, recently named in Becker's list of 110 women in medtech to know 2017, to see how she thinks MACRA will affect the industry over the course of the 2017-2021 timeline and beyond.
1. How do you think the industry as a whole will have to change to address MACRA?
Answer: If the ultimate goal for the industry is improving quality outcomes, then MACRA is certainly one way to push things in that direction. Meaningful Use was more about deployment, but MACRA is shifting the conversation to become more outcomes oriented. A lot of the uncertainty is because this is in the middle of Meaningful Use Stage 3. But if physicians are already reaching for these standards, the transition won’t be insurmountable. Using a certified EHR will not be going away, and quality reporting is not going away. CMS did make accommodations around the time crunch in the final rule with the "Pick Your Pace" plan. Clinicians or groups can submit a minimum amount of data for 2017 or they can do full reporting for at least 90 days.
2. What are your thoughts on MIPS (Merit-based Incentive Payment Systems) vs. APMs?
Answer: They are really two different programs. It's based on who you are, where you are, and what your participation in the health system looks like.
With MIPS, which is the program most clinicians will be following, it’s all about expanding patient access and improvement activities. To perform improvement activities, there are a number of things practices can do. They could provide some kind of 24/7 communication, use telehealth services, collect patient satisfaction data, or start implementing some population health strategies. Providing patients with additional access to care is in line with MACRA’s overall goal of improving the quality of care and involving patients in their own care.
An Advanced APM on the other hand is a totally different path. In this plan you structure agreements with various health system parties to improve care, which can take time. There are a number of ways to do this, such as joining an ACO. An Advanced APM means you take on a financial risk, but the trade off is if you think you can do well and reach these standards, then all of the funds you saved roll into your profits. It can take time for a healthcare organization to position themselves into this APM track. Beginning in 2018, ACOs will have the opportunity to join a Track 1+ Model, which will test a payment design that incorporates more limited downside risk than is present in tracks two or three of the Medicare Shared Savings Program (Shared Savings Program).
The end goal is to build a bridge that eventually gets organizations off of the MIPS track and onto Advanced APMs.
3. Some practices in rural areas or located in areas where there is a shortage of healthcare professionals can be provided with technical assistance by the regulatory board. How will EHR technology companies help facilitate that with critical access hospitals?
Answer: For participating critical access hospitals and rural practices using MEDITECH software, MEDITECH provides support through phone assistance and our MACRA Resource Page, which includes details on reporting options, guidance documents, and e-learnings.
4. Is MEDITECH making changes to its reporting functionality to meet MACRA requirements?
Answer: We’ll be expanding upon our already robust functionality. PQRS reporting was based on 2014, and then 2015 guidelines, but we’re going to keep offering more and adding to the catalog of reports. We recently posted a support update on the MACRA Bulletin Board, and we are making sure that our system will provide the data needed to meet MACRA requirements.
5. Many MACRA initiatives revolve around patient engagement and population health - what functions do you think will be most important to these requirements? Why do you think this is such a large focus of the initiatives?
Answer: The focus is on patients because MACRA is, in essence, outcome-oriented. Patient portals, e-Prescribing, care coordination, registries, and other patient centric functionalities will be a huge focus while working towards meeting MACRA standards.
6. What are the best resources available where healthcare stakeholders can find more information about MACRA?
To learn more about MACRA, explore the resources below: