October 10, 2017

Most Clinicians Still Do Not Know About MACRA

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Major financial penalties loom for providers not following reporting requirements.

We are more than halfway through the first year of the Medicare Access and CHIP Reauthorization Act (MACRA), and a majority of clinicians still do not understand the program.

In fact, the Centers for Medicare & Medicaid Services (CMS) reported that an estimated 40 percent of providers are unaware of the MACRA requirements, and even fewer provider extenders, such as nurse practitioners and nurses, understand the program.

The deadline to start tracking data under the Merit-Based Incentive Payment System (MIPS) is quickly approaching. CMS made some adjustments for more than 800,000 doctors who are getting a "pass" based on practice size and Medicare patient volume, but over 400,000 providers are being required to report under MIPS this year.

MACRA became law in 2015 with the Quality Payment Program. The affiliated financial penalty is to begin in 2019, based on 2017 compliance. Data reporting requirements kicked in on Oct. 2.

Just a reminder, under the MIPS Quality Payment Program: there will be a 4 percent penalty payment in 2019 for data not reported after Oct. 2, and each year that figure grows. At this point, if providers do not report by 2020, there will be a 9 percent reduction in payments. Under the Alternative Payment Model (APM, which most providers have elected not to consider, since it is high-risk, it seems like an Accoutable Care Organization operating under a modified bundled payment program, with significant stress on the coordination of care for the patient.

In spite of a great deal of information being readily available and the new buzz in the healthcare arena, again, still, a majority are not well-informed about MACRA. Maybe after the other mandates – such as those put in place by the Patient Protection and Affordable Care Act (PPACA), electronic medical records (EMRs), and bundled payments – no one is taking it seriously. Some thought the new Republican control of all three branches of government meant that they didn’t have to do much of anything. Unfortunately, many electronic health record (EHR) systems are not prepared to support the clinical care function operating under the new program. None report the requirements with MACRA.

Now, providers and EHR vendors are not the only guilty parties. CMS has not outlined exactly how providers will be judged under these two programs. One suggestion I would make is to review a web resource from the American Academy of Family Physicians MACRA Ready materials, available online at http://www.aafp.org/practice-management/payment/macraready.html.

Program Note: Listen to Lyman Sornberger discuss MACRA on Talk Ten Tuesdays today at 10 a.m. ET.
Lyman Sornberger, MBA

President and CEO for LGS Health Care and Chief Health Care Strategy Officer for Capio Partners. Prior to his roles at LGS Healthcare and Capio Partners, Sornberger was the Executive Director of Revenue Cycle Management for Cleveland Clinic Health Systems (CCHS) from 2006 – 2012. This role comprised of the Revenue Cycle Management for all 11 Cleveland Clinic Health Systems Ohio and Florida Hospitals and 1,800 Foundation Physicians. His responsibilities included all CCHS Patient Access Services, Health Information Management and Billing. Prior to his affiliation with CCHS Mr. Sornberger was with the University of Pittsburgh Medical Center for 22 years as a leader in revenue cycle management. Sornberger is a graduate from the University of Pittsburgh with a BS and Masters Degree in Business.

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