Use MACRA Flexibility to Prepare, Not Slack Off

Welcome to Editor's Corner. Here, the editors of Physicians Practice will share their thoughts on the happenings in healthcare and look at the industry from a broader viewpoint.

The teacher has given his students a bit of a reprieve, but that doesn't mean they should wait until the last minute to do the assignment.

Last week, CMS cut physicians some slack by easing reporting requirements for the quality payment program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Instead of full-year reporting in 2017 with the potential for a negative payment adjustment in 2019, physicians can now "pick their pace." This means they can avoid a negative payment adjustment in 2019 under MACRA by simply testing compliance next year. All they have to do is submit some data to the quality payment program.

Understandably, many physician advocacy groups were happy to receive this news. The time for preparation (the final rule is expected to publish sometime late October/early November) for CMS reporting that starts Jan. 1, 2017, was incredibly short. How were practices expected to get up to snuff in two months or less?

They weren't and that's why this flexibility was necessary. Now that's in place, I think physicians should heed the warning from John David Goodson, staff internist at Mass General Hospital and associate professor at Harvard Medical School. As Goodson said to us, "This is a good opportunity to figure out how [physicians] want to do this. It's a really bad idea to be complacent…it's really [giving practices] the entire year of 2017 to [prepare] and then things start cooking in 2018."

Physicians might not like MACRA. They might hate the acronyms MACRA, MIPS [Merit-Based Incentive Payment System], and APMs [Alternative Payment Models]. They might not even realize what those mean or what they are. I'd wager a good percentage of physicians don't.

It doesn't really matter at this point because MACRA is the law of the land. It was bipartisan legislation signed into law by President Obama. As many policy experts have said to me, it's not going anywhere. With this being the case, physicians have to get ready for this new world.

Once the final rule is in place, it's time to get work. Will complying with MACRA regulations - either MIPS or through an APM - be a challenge for small practices? Yes. Especially, if CMS doesn't ease up some of the requirements in the final rule, as MGMA, AMA, and many others have requested. As Goodson said though, "Small practices shouldn't be intimidated by the new world of MACRA. They may be better off than large enterprises. They have good relationships to depend on in their communities and can track [patient outcomes] better."

One thing practices of all kinds have going for them to comply with MACRA is a bundle of resources at their fingertips. There are resources on complying with MACRA from all sorts of places: CMS itself, organizations like AMA and MGMA, system vendors, consultants, and of course, Physicians Practice. As Andrew Gurman, an orthopedic hand surgeon from Hollidaysburg, Pa., and president of the AMA, said to us in an interview, "Start looking at the things you can look at when it comes to the quality measures…everyone wants doctors to succeed with MACRA, there are resources for that."

ICD-10 used to get delayed every year. Often, you'd talk with providers and they said they couldn't aptly prepare because it seemed as if it'd be delayed forever. That will not be the case with MACRA because the timelines are baked into the law. Moreover, CMS is gearing up for a switch to value-based care and MACRA is the vehicle in which they'll make that transition more of a reality.

The train has left the station. You can both continue serving Medicare patients and get ready for MACRA, or you can get off and try another route.

Follow Gabriel Perna on Twitter at @GabrielSPerna