Black Book Report Dives Deep Into Biggest MACRA Challenges for Clinicians

May 9, 2017
A new Black Book Research report has identified the 10 top challenges that providers have with MACRA (the Medicare Access and CHIP Reauthorization Act) as it relates to value-based care and quality metrics.

A new Black Book Research report has identified the 10 top challenges that providers have with MACRA (the Medicare Access and CHIP Reauthorization Act) as it relates to value-based care and quality metrics.

For the analysis, Black Book Research crowdsource-surveyed 8,845 physician practices from February through April 2017. The first reporting period of MACRA’s Quality Payment Program kicked off in January, and in year one, most Medicare clinicians will be take advantage of flexibilities offered to them by the government. In other words, as long as they report some quality data, they’ll avoid a negative payment adjustment.

MACRA includes two payment tracks that eligible Medicare clinicians can take part in that will determine their payment adjustments in future years. Early on in the program, most of these clinicians are expected to participate in the less risky Merit-Based Incentive Payment System (MIPS) track as opposed to the Advanced Alternative Payment Models (APMs) track.

Below are the 10 MACRA challenges Black Book identified, with analysis:

The market for MIPS compliance technology is booming— Seventy-seven percent of physician practices with three or more clinicians seek to buy MIPS compliance technology solutions by Q4.  “Given the magnitude of the changes, the hunt is on for the best MIPS incentive enablement resources,” said Doug Brown, managing partner of the survey organization Black Book Research.  However, 92 percent of respondents were not aware of any branded technologies from vendors that support all MIPS registry measures for 2017 reporting besides their EHR (electronic health record). What’s more, 89 percent said the primary reason for acquiring MIPS support software was not quality measurement, but because they can’t decipher their MACRA earning potential.

MACRA is sparking ambulatory EHR optimization— Eighty-three percent of users of the top eight EHR systems are upgrading or optimizing their systems for MIPS compliance. EHRs can be a practice’s strongest asset in collecting and submitting data. However, 72 percent of practices surveyed using EHR products not considered in the top eight largest systems (Cerner, Epic, Allscripts, eClinicalWorks, NextGen, athenahealth, Practice Fusion, and GE Healthcare) stated they were not working with their vendor to ensure they were prepared for MIPs measures and can properly report the data.

Beginning in 2018, physicians must use EHR technology that is certified for 2015 and this requirement also burdens physicians utilizing small EHR vendors that have not been 2015 certified. “The replacement market is heavily leaning to these largest eight EHRs from small EHR vendors and expected to increase through 2018 as some providers had previously invested in EHRs that do not acclimate to agile change at scale like MACRA demands,” said Brown. “EHR companies are not required by MACRA to update their technology so providers are ill-equipped should the practice stick with their uncertified EHR.”

MACRA consultants are a hot commodity— Eighty percent of all surveyed practices agree that performing a technology inventory is essential to see how far their current EHR and other traditional data systems can take them. But, 75 percent of practices with three or less physicians that struggle to manage the technology basics but state they cannot afford paying a consultant in 2017.

Large practices gear up MACRA resources— Eighty-one percent of independent physicians in practices of four or more clinicians reveal they have not grasped how to align data with the reporting measures. “Seemingly, the MACRA requirements appear fairly easy to meet, you simply attest to at least one performance improvement activity. However, the reality will be significantly more difficult as smaller practices in particular begin preparing for risk,” said Brown.

Outsourcing will be a last minute MACRA play for many practices— Eighty percent of provider organizations that have not developed their MACRA strategy or plan expect to select a turnkey software or outsourcer to catch up as best they can for 2017. By the end of Q2, the scramble to get programs in line will consume many physician practices.  “It is imperative that providers grasp the requirements of MACRA now to ensure they put the right strategy in place, since the pace of the program only accelerates in 2018 and beyond,” said Brown.

Even more independent physicians will be driven to sell their practices—Seventy-five percent of remaining independent clinicians are considering selling their practices to hospitals or group practices to eliminate the administrative burden and capital costs, while 68 percent view MACRA as a burden or bust to their independent practice by 2020.

Shifting reimbursement to those with data—In 2019, the first payment adjustment year, MIPS will take approximately $199 million from eligible clinicians below the performance threshold and redistribute those funds to providers above the performance threshold. Eventually the redistributed dollars will be equivalent to 9 percent of Medicare physician payments.  In addition, for the first five years $500 million in supplemental funding will be awarded each year. During this time, MIPS adjustments could add 10 percent in addition to the maximum positive payment adjustment which is three times the amount of the penalty. As such, 64 percent of hospital networked physician organizations are incorporating performance incentives in provider compensation models to incentivize MIPS reporting success. And, 88 percent of hospitals surveyed report they are seeking ways to ensure individual performance scores are reflected in the compensation of the physicians they employ.

Individual physician reputations are at risk— Fifty-four percent of all survey respondents were unaware that the Center for Medicare and Medicaid Services (CMS) will publish this data on their Physician Compare website, as well as be accessible by other third party rating systems including Yelp, Angie’s List, Health Grades and Google. And, 69 percent of the surveyed practice managers are aware they need to report on six quality measures yet only 22 percent were aware they had the opportunity to choose the metrics they believe represent strengths to the practice. Although essential to continuous improvement and practice success, 94 percent were unaware or unsure of how to predict their 2017 MIPS scores.

Small and rural providers are rallying for ACO inclusion—ACO (accountable care organization) participants can more easily achieve high scores compared to other MIPS participants increasing the likelihood of avoiding MIPS penalties and earning an exceptional performance as MACRA requires 30 percent of the MIPS score to be based on resource utilization. However, Track 1 ACO participants are held accountable for their cost in their ACO, not MIPS. So, 67 percent of small practices are considering joining an ACO to avoid penalties for generally lower scores due to a lack of infrastructure. Additionally, 82 percent of providers in rural areas are joining ACOS to avoid MIPS penalties due to their higher cost structure.

Provider cost and quality scrutiny propelled by MACRA— A Q4 2016 Black Book survey revealed 88 percent of consumers under age 44 are aware of online physician rating websites, as are 55 percent of consumers over age 45. And, 12 percent of all healthcare consumers said they had viewed an online physician rating site in the past year.

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