If provider discontent doesn't prompt a delay, the controversial MACRA legislation will become reality in just six months, shaking up traditional physician reporting and reimbursement as healthcare knows it.
And while the proposed MACRA rule is still in flux, the bones of the law aren't expected to change, notes Eric Levin, McKesson's director of strategic services. From this point forward, he says, care coordination will be the ticket to success in eventual MACRA value- and performance-based healthcare models.
"As clinical alignment and care coordination increase, if you are not participating in some type of value-based care program, most likely you're not being reimbursed or rewarded for that work," Levin told participants in The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System, a July 2016 webinar now available for replay.
In outlining MACRA's intent, Levin chiefly focused on the Merit-Based Incentive Payment Systems (MIPS) rather than the second reimbursement path, alternative payment systems (APMs), since the majority—88 percent—of physicians is expected to qualify under MIPS rather than APMs.
Zeroing in on MIPS, Levin reviewed eligibility, performance categories and data submission options, among other points. He then detailed the plethora of current and planned technical assistance options from CMS—including eventual practice transformation networks to provide peer-level support to physicians—before offering practical ways physician practices can prepare now for MACRA.
His six immediate action steps for practices included dipping a toe into analytics and data aggregation. "Look at the data. Learn how to risk-stratify. See the gaps in care you currently have and where those can be filled in so you're not just measuring but actually improving quality," Levin advised. The CMS Quality and Resource Use Report is useful for estimating a practice's MIPS score, he added.
In offering six additional tactics to become MACRA-ready, Levin recommended physician practices acquaint themselves with national benchmarks as a primer in quality measurement.
And on Levin's accompanying five-point MACRA implementation checklist is a reminder to stay current on CMS's proposed and final MACRA rulings. Fostering relationships with technology vendors wouldn't hurt either, he added.
His final points covered additional MACRA implementation resources, including education from provider associations, as well as the benefits of Patient-Centered Medical Home recognition and engagement in CMS's Chronic Care Management initiative in MACRA preparation.
"These programs will really help you begin the value-based journey if you have not started."
Levin emphasized providers should not wait for the final rule. Rather, physician practices should "learn how to focus on quality outcomes and costs, helping focus on the patient as well as that patient-provider relationship. Look at how you can identify ways to increase inexpensive patient encounters."
Before concluding, Levin answered participants' questions on how MACRA and MIPS will impact specialty providers; lessons practices can take from participation in the Physician Quality Reporting System, Meaningful Use and other value-based initiatives to enhance MACRA success; recommendations for small and solo practices; and other key concerns.