4 Tips to Strategically Align with MACRA

Are you overwhelmed by the detailed requirements of the Medicare Access and CHIP Reauthorization Act (MACRA)? If yes, your practice is not alone.

According to Pa.-based Stoltenberg Consulting's fifth-annual Health IT Industry Outlook Survey, 64 percent of providers say they feel "unprepared" or "very unprepared" for managing and executing MACRA initiatives.

MACRA holds major significance for these confused providers because its Quality Payment Program (QPP) centers on improved patient outcomes, activities for quality clinical care practices, efficient use of medical resources, and the meaningful utilization of EHRs. The QPP replaces the outdated Sustainable Growth Rate (SGR) formula, moving away from fee-for-service care.

Now practices are tasked with the job of thinking beyond claims data in the transition to value-based care and eliminating the data-silo mentality. This represents a major upheaval for many, and a challenge for all.

But while 68 percent of survey respondents said preparation for MACRA should be a combined effort with clinical, financial and IT departments working cohesively, pulling together the right mix of representatives is not always easy. In fact, 82 percent of survey respondents admitted that finding qualified health IT representation is an obstacle.

Considering the ongoing reporting burden, reimbursement impact, and industry significance tied into MACRA's QPP, lack of readiness is widespread across already stretched physician practices. Many still struggle to understand the program altogether, assumed it would be delayed or hindered by a repeal of the Affordable Care Act (ACA) or don't know how to jump-start reporting alignment. To overcome physician practices' already limited resources, consider the following four tips for making the most of MACRA:

•Set the groundwork. Establish a working MACRA governance committee with cross-departmental representation. Financial representation can take the lead in selecting reporting measures for the practice under the Merit-based Incentive Payment System (MIPS) that will be most operationally effective among the varied options laid out by CMS. For a solid foundation, the team needs to absorb a strong understanding of MACRA to effectively identify reporting gaps. Resources like this MIPS participation factsheet cover program exemptions, participant expectations and guidelines.

Even within physician practices where there isn't a designated IT department, it's important to bring in the voice of the individual who best knows how to maintain, extract and analyze practice data. The go-to IT expert needs to work with financial and clinical representatives to help the practice achieve success under MACRA. If you can’t pinpoint that voice, it may be time to bring in a third-party IT advisor, who can assess and capture the whole picture of care by best maneuvering the EHR system.

•Know your current standing. For smaller practices, the initial question is whether or not they have to report at all in the first year. All clinicians required to participate in MIPS should have received participation status letters by the end of May, according to CMS. Likewise, all physician practices will be given the status of each MIPS clinician associated with their Taxpayer Identification Number (TIN). Another helpful resource is CMS' recently released MIPS eligibility tool. MIPS-eligible clinicians-including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse practitioners-can look up their status with their National Provider Identifier (NPI) number.

•Accurately gather all pertinent data. To effectively select a reporting path, practices need to think beyond claims and reimbursement data, knowing that the transition to value-based care relies on the whole picture of patient health. Review helpful reports like your Quality and Resource Use Report (QRUR), which ties in the Physician Quality Reporting Program (PQRS) and Value-Based Payment Modifier to assess quality and cost performance. This historical data can shed light on which measures yield the highest potential for positive reimbursement adjustments.

•Prepare for the future. Even if your practice is exempt from reporting this year, you should still consider reporting requirements for subsequent years. MACRA requirements become more stringent in the future, as the potential for reimbursement or penalty increases. Remember that participating in 2017 offers practices the chance to solidify footing for a long-term strategic plan to best utilize reporting measures for maximum operational effectiveness and reimbursement opportunity.

When planning for the future, consider how the practice's makeup will change. While some clinicians may be exempt now in their first year with Medicare Part B, they will likely be required to report next year (if they meet Medicare patient number and billing level minimums). How will that impact your practice's figures? Will new physicians be added to the practice or leave? Consider the impact since there is a two-year gap between financial reporting and reimbursement adjustments. Also think about what medical specialties are represented within the practice. Some QPP measures may correlate more easily to specific-focus care programs already in place for chronic disease groups.

Whether your practice is just beginning its MACRA journey or looking down the road for future path alignment, follow these tips to maximize QPP reimbursement potential.

With the value-based care evolution of healthcare well underway, practices can no longer blindly submit data. Instead, they must strategically utilize care information to display quality care, improved patient outcomes and efficient use of EHRs and resources.

Joncé Smith has more than 30 years of healthcare industry and management experience with work spanning the public, private, academic and governmental sectors for acute facilities and large physician practices. With a special focus on revenue cycle optimization and business office transformation, she serves as the vice president of revenue cycle management at Stoltenberg Consulting, a leading healthcare IT consulting firm.