Challenge 1: MACRA
“MACRA is the biggest thing that’s hit healthcare payments in a generation,” says John Goodson, MD, an internist at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School. “This is going to be transformative.”
And even though MACRA begins taking effect January 1, many physicians still don’t know what they need to do to comply.
“Each practice needs a Paul Revere to ride through shouting, ‘MACRA is here, change is here,’” says L. Patrick James, MD, chief clinical officer, health plans and policy and medical affairs for Quest Diagnostics, a healthcare technology provider. “Physicians need to get together and accept it. If you haven’t already started, you need to get started ASAP.”
Experts recommend the following:
Accept reality. Healthcare reimbursements are migrating from volume to value. MACRA will most likely serve as the road map for other payers, so get used to the reporting requirements, says James. “Physicians have gotten a lot better over the years with electronic health records (EHRs), but it’s going to be even more important that physicians aren’t just ‘doing’ but documenting,” says James. Documenting and reporting every treatment through a certified EHR or other approved method is the only way physicians can get paid for services.
Get educated. The law directs physicians to choose one of two reimbursement paths—advanced alternative payment models (APMs) or the Merit-based Incentive Payment System (MIPS). Most small practices probably will opt for MIPS, which measures quality, advancing care information (meaningful use) and clinical practice improvements to start (resource use will be included later.)
“Figure out what you are already doing that you can get credit for under MIPS that you haven’t declared,” says John Squire, president and chief operating officer of Amazing Charts, an EHR vendor. “Many are based on treating diseases to improve outcomes and using prevention screening—most physicians are doing that today.”
Understanding these gaps between what you already do and what MACRA requires is key to a successful transformation. “Take a deep breath and don’t panic,” Squire says. “It can be daunting when you look at your to-do list, but you don’t have to do it all at once.”
Develop a plan. MACRA compliance isn’t going to happen without a commitment to change management, says James. “Create a vision, get your practice together and develop a plan,” he says.
This includes making sure all services are billed properly, says Goodson. Ensure that every diagnosis is part of the billing for that patient, and that all ICD-10 codes are attached to the bill. With the focus on patient wellness, make sure the plan includes scheduling annual wellness visits and transitional care management (TCM) visits, when appropriate.
“For TCM visits, there are few documentation requirements and they are quite reasonable,” says Goodson. “These visits benefit both the patient and the physician.”
The increased contact also helps enhance overall engagement, which makes for happier patients and better outcomes, he says. “The better the relationship between doctors and patients, the better the doctor can manage resource allocations for those patients,” Goodson adds.
This is one area small practices may have an advantage over their larger competitors, because physicians may know their patients better and know where they can influence behavior and where they can’t, Squire says.
When planning for MIPS, remember that some easy points are available just by following good practice procedures, says Squire. As an example, he cites the practice improvement category, which accounts for 15% of the total MIPS performance score. The category offers easy wins for those who plan and document for steps such as reserving time for same-day appointments, performing medication reconciliation and communicating with patients via a portal or messaging.
Under MACRA, in addition to the 15% for improvement activities, quality accounts for 60% and advancing care information is 25%. (Cost won’t be counted until 2018.) This composite score is used to calculate financial bonuses and penalties. “Make sure you know the components of the MIPS scores and plan for them,” Squire says.
And remember, the healthcare industry will be developing products and services that support MACRA, so talk to vendors to find out how they can help. Squire suggests starting by seeing what technology your EHR vendor can deliver to assist with the changes, and branch out from there. For example, talk to lab vendors to find out what they can do with lab results or digital images to help with the advancing care information score.
Don’t procrastinate. MACRA was originally supposed to take effect at the start of 2017, but the Centers for Medicare & Medicaid Services (CMS) has delayed full implementation until January 1, 2018, allowing practices to submit partial information or participate only for part of 2017. “Have a plan for 2017, but be ready to go in 2018,” says Squire. “The delay was a reprieve, but CMS is not rescinding the rule. Don’t ignore it.”