Joncé SmithThe first reporting year under the Medicare Access and CHIP Reauthorization Act (MACRA) is well underway, but lack of readiness nonetheless plagues many in the healthcare industry. In a recent survey conducted at the HIMSS17 conference in February, 64 percent of healthcare providers revealed they are “unprepared” or “very unprepared” for MACRA’s Quality Payment Program (QPP) reporting requirements. This unprepared state is due in part to many believing MACRA would be delayed, because of the size of the legislation as well as the reporting burden of the QPP.

MACRA’s QPP requires data collection to start between Jan. 1 and Oct. 2. For this first reporting year, providers are required to send in performance data by March 31, 2018. First payment adjustments based on performance are expected to go into effect on Jan. 1, 2019.

The stakes are higher than ever, too. Providers who chose the Merit-based Incentive Payment System (MIPS) track and score well will receive annual bonuses starting at 4 percent in 2019. However, physicians who don’t meet all requirements are expected to face penalties. For these reasons, preparing for MACRA and getting all stakeholders—particularly financial experts—on the same page is critical to moving forward.

Addressing MACRA Challenges

Although QPP increases provider accountability for quality outcomes and cost reduction, success in the program requires far more than the passive submission of claims data required for past programs.

Unfortunately, collaboration isn’t happening at a high level. According to the aforementioned survey, healthcare leaders identified “revising data management/reporting mechanisms to meet new reporting requirements” as the top QPP challenge (31 percent of survey respondents), followed by “motivating the entire organization to collectively work together to achieve program alignment goals” (29 percent of survey respondents).

One reason for these challenges is the natural tendency of healthcare organizations to work in data silos. Success with MACRA reporting requires a more collaborative effort across clinical, financial, and IT departments, as indicated by 68 percent of respondents, to show that selected reporting measures are fulfilled.

Best Practices for an Organization’s Financial Team

As a healthcare provider moves forward with its MACRA preparations, an important initial step should be to form a strategic, cross-disciplinary governance committee that includes representatives from IT as well as financial and clinical areas to ensure everyone’s voice is heard.

Within this committee, the financial group should take the lead in selecting the program measures for the organization’s reporting path, under either an alternative payment model (APM) or MIPS. For example, under MIPS’ quality performance category, finance and clinical leaders can collaborate on selecting from the many available options the handful of measures that are the best fit for the provider group or organization.

Choosing these measures is a significant task because MIPS’ quality performance category replaces the Physician Quality Reporting System (PQRS) and accounts for 60 percent of a MIPS score. The financial group has insight regarding what values current reporting can yield for more efficient alignment. Because the program’s payment opportunity or penalty is driven by a minimum number of measures for each category rather than by designated, specific measures, an organization can select those it can easily meet while being the most operationally effective.

Moving forward, providers need to create a solid MACRA strategy, as the pace will only accelerate after 2017. Although healthcare organizations can pick their own pace in 2017, they require a full year of data in 2018. Moreover, the cost performance category holds no weight in 2017, but by the 2019 reporting year, it makes up 30 percent of a composite score.

CMS offers flexibility in the program’s first year to provide healthcare organizations with an opportunity to reassess their performance improvement efforts as they prepare for long-term success in a value-based system. By focusing on boosting the financial department’s role in meeting MACRA requirements, an organization can find itself ahead of the curve.


Joncé Smith is vice president of revenue cycle management at Stoltenberg Consulting, Bethel Park, Pa.

Publication Date: Monday, May 22, 2017