3 Ways to Prep Physicians for MACRA's Unknowns

Debra Shute, May 5, 2016

With a complete roadmap unavailable, and rank-and-file physicians not really paying attention, the next-best guides for physician practice leaders include existing programs such as PQRS, the value-based modifier, and meaningful use.

The future of physicians isn't much clearer than it was before the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA)  last week.

Despite medical groups' pleas to delay the January 1, 2017, start date of the first reporting period under MACRA's Merit-Based Payment Incentive System (MIPS), CMS has so far stuck to its guns, leaving medical groups just a month or so after the release of its final rule—expected in late fall of 2016—to prepare.

Physicians will need to digest the regulatory information, figure out their quality measures, and get their systems ready to report data that won't result in a penalty or reward until 2019.


Related: Physicians Stymied by MACRA's Unknowns


Anders GilbergSo with the timelines firmly set, healthcare leaders should not wait to prepare for changes.

But that lag time potentially undermines the purpose of the program, and represents one of many problems the Medical Group Management Association (MGMA) intends to share with CMS during the public comment period ending June 27.

"The feedback mechanisms are too removed from the performance years," says Anders Gilberg, MGMA's senior vice president of government affairs.

"If you're really going to attempt to improve quality through these programs—not have them just be reporting programs with incentives tied to reporting—you need feedback.

You need timely, actionable information. And you need incentives to be closer to when you're actually providing and measuring that care."

Good News, Bad News

A less obvious issue, according to Gilberg, is CMS's proposal to reduce the total number of quality measures practices will need to report under MIPS to six from the nine currently required under the Physician Quality Reporting System (PQRS).

"On first blush, that looks like an improvement," he says.

"But at the same time, CMS proposed to raise the threshold you need to achieve those measures as high as 90% for some… while for some, 50% has been hard to achieve, either because of the nature of the measures or difficulty in reporting."

More positive, however, is CMS's willingness to allow medical groups to select a set of quality measures (which account for half of the total score in year one of the program) that applies to their specific practice, says Chet Speed, JD, LLM, vice president of public policy for the American Medical Group Association.

Debra Shute

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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