Preparing to switch over to MACRA is no easy task for both health practitioners and health organizations. Thankfully this MACRA Data Submission guide provides a comprehensive guide on how to do so. It includes in-depth answers to frequently asked questions by physicians and an update on the current state of affairs of MACRA. Below I’ll summarize some of the information provided by the guide but be sure to read the full guide in order to be well versed in all that MACRA is an all that it requires.
The Current State of MACRA Affairs
The current state of MACRA is, for lack of a better description, fragile. There was a 2016 Survey of America’s Physicians from the Physicians Foundation and it showed that 48 percent of physicians plan to cut back on hours, retire, take a nonclinical job, switch to “concierge” medicine, or take other steps that would limit patient access to their practices. Breaking this down, 14.4 percent say they will retire in the next one to three years compared to 9.4 percent who said so in 2014. Meanwhile, 21 percent will cut back on hours and 13 percent will seek non-clinical jobs. Doctors are overcome by invasive regulations, and this has caused the widespread of poor morale. According to the Deloitte Center for Health Solutions 2016 Survey of US. Physicians, 50 percent of respondents said they have never heard of MACRA, while 32 percent recognize it by name but are not familiar with its requirements. Twenty-one percent of self-employed or independent physicians said they are somewhat familiar with the law, compared to nine percent of physicians employed by hospitals, health systems, or medical groups owned by them. Eight-in-ten say they prefer traditional fee-for-service (FFS) or salary-based compensation as opposed to value-based payment models, some of which qualify under MACRA’s alternative payment model (APM) track. Seventy-four percent of respondents believe that performance reporting is burdensome and 79 percent do not support tying compensation to quality, both requirements under MACRA. Fifty-eight percent of physicians say they would opt to be part of a larger organization to reduce individual increased financial risk and have access to supporting resources and capabilities.
Some Very Important Frequently Asked Questions
What are the aims of the Quality Payment Program?
Considering that many doctors and physicians are not comfortable with and are not willing to readily accept the value-based-payment method it begs the question: what really is its aim?
Answer: The Quality Payment Program that exists under MACRA unifies several existing policies to support care improvement by focusing on better outcomes for patients, decreasing provider burden and preserving independent clinical practice. The Quality Payment Program also promotes adoption of APMs that align incentives across healthcare stakeholders. It advances existing efforts of Delivery System Reform to ensure a smooth transition to a new system that promotes high-quality, efficient care by unifying these legacy CMS programs.
Who is required to participate?
Answer: The list of eligible participants in the MIPS track and MACRA extends
well beyond physicians. It includes Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse, Anesthetists, and groups that
include clinicians who bill under Part B. Individuals who bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year must participate in the QPP. Both requirements must be met. Approximately 14 percent of providers will be low volume and, therefore, not required to participate. Also, eligible physicians who are newly enrolled in Medicare are excluded from reporting in the first year. Anyone already part of an Advanced APM will also participate. To participate in MIPS, providers must be a physician, physician assistant, nurse practitioner, clinical nurse specialist, or certified registered nurse anesthetist.
CMS estimates that between 592,000 and 642,000 eligible clinicians will be required to participate in MIPS in the 2017 transition year.
What if I don’t report at all?
As already established, many physicians are not even aware of MACRA and those who are are not exactly pleased with it. So what if a physician fails to report?
Answer: Not reporting has its consequences, in addition to a four percent penalty. All data will be publicly reported on the Physician Compare website. Anyone contemplating sitting out should consider the potential impact not only on reimbursement but also on future job search efforts, as well as reputation with prospective patients.