MACRA: IT shops can help providers thrive under the new payment model

The regulation as it stands today is confusing. Don’t panic. Crush it instead. Experts share tips on how to make that happen. 
By Diana Manos
07:21 AM
MACRA IT payment model

Many providers are currently wondering how they will survive under the forthcoming Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) payment model because, to put it mildly, reimbursement is set to change drastically.

“People keep whining and crying about MACRA, but the ones who aren’t whining are going to crush it,” said Justin Barnes, chief growth officer for iHealth Innovations. “Attitude will be important.”

Indeed, keeping the transition to MACRA on track will demand a positive mental attitude among hospital executives and staff.

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Timing matters
With public comments closed on the 900-plus-page regulation and the Centers for Medicare and Medicaid Services acting administrator Andy Slavitt publicly saying CMS would be open to pushing back the timelines, hospital executive face more questions than answers right now.

“The proposed rule is highly unlikely to be issued as is. Things are likely to change,” said Robert Tennant director of health information technology policy for the Medical Group Management Association.  

[Also: MACRA, what's that? Half of doctors don't know, Deloitte says]

Tennant said that MGMA expects the rule to come out between Oct. 1 and Nov.1, but if it’s much later than that the next administration may put it on hold for a while and make changes to it – fewer alterations if it’s a Democratic president.

“Very rarely does a new administration say, ‘whatever they did in the past will work fine for us,’” Tennant said. “They always want to put their own stamp on it.”

Communicate, communicate, communicate
Uncertainty about timing and what the final rule might ultimately look like it make it all the more important to open lines of communication with relevant industry trade groups, Tennant said, as well as technology vendors, of course, including EHRs, analytics vendors, revenue cycle management, practice management and others.

Will they be certifying their product against 2015 requirements? This will be required by 2018 under the proposal. If they have no plans of doing this, you might have to rip and replace an entire system, which could be costly.

Also: Check to see whether existing contracts stipulate that your EHR product will be certified to the highest available degree. If not, you could be in trouble when MACRA kicks in — and Tennant said that as of now there are no vendors certified to 2015 requirements.

Get your rules and regulations in order
The first step is to stop and think about what you are currently doing that can be applied to MACRA.

Are you participating in the physician quality reporting system (PQRS)? If not, you should be. A significant part of the Merit-Based Incentive Payment System (MIPS) — the portion of MACRA that applies to physicians — will be based on PQRS. It’s also a good idea to order your Quality and Resource Use Report (QRUR) from CMS to see where your performance stands compared to peers.

This also means learning MACRA and knowing it inside-and-out. Barnes, who has worked for years advising federal regulatory agencies and Congress on health IT bills, echoed Tennant’s sentiment that hospital executives should expect some changes between now and the final rule but he does not expect seismic shifts.

“The basic tenets have been built — and they will mostly likely stand — even if some of it is scaled back,” Barnes said. 

Mastering MACRA and figuring out how it fits into the regulatory puzzle at the very least will give you an idea on the areas needing improvement. 

Technology alone won't save you
Like so many problems in healthcare and other industries technology is absolutely critical but, even still, can only get hospitals part of the way to MACRA.

“Throwing IT at the problem won’t begin to cover it,” Barnes said. “It will take leadership skills and an ability to analyze, collect and report quality measures, and more.”

Barnes and Tennant asynchronously agreed that hospitals can thrive, not merely survive, under the risk-based environment of value-based care. But it demands proper planning.

“There will be a significant number of winners,” Barnes said. 

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