Hospitals are mostly focused on ensuring their employed physicians are ready for MACRA, although some have sought help for those who are affiliated through advanced alternative payment models.


Feb. 20—Medicare officials have begun to issue assistance to help providers adjust to Medicare’s new physician payment formula amid signs that few are prepared for the shift.

The Centers for Medicare & Medicaid Services (CMS) awarded approximately $20 million to 11 organizations to provide physicians with on-the-ground training and education about compliance with the requirements of the Medicare Access and CHIP Reauthorization Act (MACRA), according to a release.

The organizations will provide free assistance to practices with 11 or fewer physicians, helping them comply with the quality-data collection and reporting requirements of MACRA’s Quality Payment Program (QPP). The law authorized up to $100 million in such assistance over five years after CMS concluded that most small practices would fail to adequately report data and thus face steep cuts under MACRA. CMS projected the 87 percent of solo practices and 70 percent of practices with two to 10 physicians will face Medicare payment cuts under the new system.

“Providers that we are working with on these other programs are expressing concern related to mostly not understanding what it is that they are going to have to do under MACRA,” said Anya-Victoria Day, deputy director of health innovations for the Altarum Institute, which received one of the CMS grants.

“So this program will provide that education and support on how to make the changes they need to make to alleviate those concerns.”

Her organization expects to provide MACRA assistance to 35,000 mostly independent physicians across seven states. That assistance will include helping practices assess their current performance on quality MIPS categories, predict their MIPS scores, identify areas for improvement, and provide education materials to help providers understand the different aspects of the QPP.

The assistance will help clinicians choose and report on quality measures and will provide guidance on matters such as assessing and optimizing health IT. Many provider advocates have warned that small practices lack the IT infrastructure to meet MACRA reporting requirements.

“It’s not focused on health IT necessarily because it is focused on quality improvement and quality reporting but these days you cannot participate in a quality reporting program without being able to leverage your EHR effectively,” Day said in an interview. “So sort of by default it involves an aspect of helping them optimize their health IT.”

CMS also will provide MACRA compliance webinars and in-person presentations. Other MACRA-related assistance is available through Quality Improvement Organizations, the Transforming Clinical Practice Initiative, and the Health Care Payment Learning and Action Network.

Incoming Trump administration officials have underscored their commitment to continue to provide such assistance.

For instance, during Seema Verma’s recent confirmation hearing as CMS administrator, she described MACRA as “an important step forward” but emphasized the need to engage with stakeholders as quickly as possible and all the way through the process.

“Open communication is essential to success,” said Verma, who also stressed her experience learning directly from providers about how well various public-payer programs were working.

Clinicians also can seek assistance with QPP compliance by dialing CMS’s new helpline: 1-866-288-8292, with customer service available from 8 a.m. to 8 p.m. ET; and via email: qpp@cms.hhs.gov.

Preparedness Lacking

The assistance push followed a recent survey indicating providers are lagging in their preparations for MACRA, which will use 2017 quality performance to determine payments in 2019.

Only 35 percent of health system executives responding to a Health Catalyst online survey said they  had a strategy and were “well on our way to being ready” for MACRA quality reporting for 2017. Most of the respondents expected to participate in MACRA, with only 5 percent of the 37 CEOs and 94 other C-suite executives saying their organization planned to opt out of participating.

Bobbi Brown, a vice president of finance at Health Catalyst, was surprised by how few hospitals had MACRA strategies in place when the survey was conducted in late 2016. Based on provider feedback to Health Catalyst, hospitals are generally split between those looking for “quick fix” MACRA compliance assistance and those seeking to overhaul their approach so they can qualify for an advanced alternative payment model (APM).

“To have an action strategy and say, ‘Is this long-term what we want to do? Do we want to move into the alternative payment world?’—there are very few that are in that place,” Brown said in an interview.

Respondents who had a MACRA strategy for their employed providers but had not made much progress implementing it included 26 percent of small and medium-sized hospitals and 33 percent of large hospitals and health systems.

Responding organizations that planned to participate in MACRA but had no strategy included 33 percent of small and medium-sized hospitals and 24 percent of large hospitals and health systems. Among the reasons for a lack of strategy: the organization was trying to determine whether providers could profit by participating in MACRA, the work was too cumbersome, or the organization had too little information on MACRA.

Many medium-sized hospitals have told Brown that they are waiting for their electronic health record (EHR) vendor to come up with software that allows them to collect, analyze, and report the patient quality information required by MACRA.

Most organizations that had developed a MACRA strategy said they expect their physicians to do well. For instance, of the 73 executives from small and medium-sized hospitals that reported having a MACRA strategy, two-thirds expected their employed physicians to receive a bonus or break even.

Based on feedback to Health Catalyst, Brown said most hospitals are focused on ensuring their employed physicians are MACRA-compliant. But some hospitals also have sought ways to help independent physicians with whom they are affiliated through APMs.

Possible Changes

Even as MACRA takes effect, some provider organizations are urging the Trump administration to change its implementation.

Sally Pipes, president and CEO at the Pacific Research Institute, and Michael Koriwchak, MD, vice president of the Docs 4 Patient Care Foundation, recently argued in a Forbes op-edthat MACRA participation should be voluntary.

Additionally, the Medical Group Management Association (MGMA) wrote a letter to Tom Price, secretary of the U.S. Department of Health and Human Services, on Feb. 10 to urge changes that reduce the cost and reporting burden of MACRA’s Merit-based Incentive Payment System (MIPS). Most Medicare physicians are expected to fall under the MIPS category because they are not part of a qualifying APM.

MGMA urged rule changes by CMS to count quality reporting toward the overall MIPS score, rather than merely toward bonus points. The organization urged CMS to use the new Physician-Focused Payment Models Technical Advisory Committee to create more APMs. They also urged delaying requirements for providers to move to the 2015 certified EHR standards.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Monday, February 20, 2017