MACRA Delay is "Inevitable," Says Expert

Welcome to the Physicians Practice Pearls Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at editor@physicianspractice.com.

Joining us for the most recent episode of the Physicians Practice Pearls podcast were John David Goodson, staff internist at Mass General Hospital and associate professor at Harvard Medical School and John Squire, president and COO of AmazingCharts.

Recently during a Congressional hearing, CMS Acting Administrator Andrew Slavitt suggested there might be a delay to the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA currently is set to take effect on Jan. 1, 2017, and will institute a payment adjustment beginning in 2019.

Many medical groups, such as the AMA and American Academy of Family Physicians (AAFP), are advocating to delay MACRA to give physicians more time to prepare for the switch to new payment models - either the Merit-Based Incentive Payment System or the Alternative Payment Model. If there isn't a delay, practices will have two months after the final rule is announced, around early November, to begin implementation of the new program.

We asked Goodson and Squire to share their thoughts on the necessity of a delay to give physicians more time to comply with the rules of MACRA. "The delay is required. It was 1,000 pages of legislation. They got around 3,900 comments. A lot of it was around the impracticability of the timeline," Squire said, who added there could be problems for small practices that don't have the necessary resources to comply with MACRA. "Clearly they didn't have small practices in mind when they drafted the legislation."

Goodson was a little more optimistic for small practices.

He said they have to be strategic in the way they move forward, with or without a delay, focusing on areas where they can optimize fee-schedule revenue and make a concerted effort to engage patients to improve patient outcomes. About the delay, he said, "I think it's inevitable," but cautioned three or six months would be minor in terms of what practices have to do to get ready for MACRA.

Later in the podcast, Squire and Goodson talked about the IT efforts that practices would need to undertake to get ready for MACRA. Both agreed that population health management would be vital to succeeding.

Finally, they shared their advice for practices on the lead up to MACRA. The first thing practices should do, Goodson said, was to decide if they wanted to continue to participate with Medicare. If they do, he says they have to prepare and optimize the IT systems that are needed comply with MACRA. He also said you need to engage patients so they "feel part of your practice in a meaningful way." Squire added, "They should relook at the way their office works and optimize or redesign the roles [of staff members] to do what needs to be done under MACRA."

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