Through a crowd-sourced survey of almost 9,000 physician practices from February through April, Black Book research has delineated the 10 top MACRA trends that are challenging providers in terms of value-based care and quality metrics.
MACRA replaces the sustainable growth rate formula in the transition from fee-for-service reimbursement to payment models based on outcomes. A complex web of alternative payment models, the rule -- administered by the Centers for Medicare and Medicaid Services -- has left some providers scrambling to ensure they're compliant, though it promises rewards for those who deliver value.
1. The Market for MIPS compliance technology is booming
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Of physician practices with three or more clinicians, 77 percent are seeking to buy Merit-Based Incentive Payment System Compliance Technology Solutions by the fourth quarter of this year. Yet 92 percent of respondents were not aware of any branded technologies from vendors that support all MIPS registry measures for 2017 reporting, besides their electronic health records.
Meanwhile, 89 percent said the primary reason for getting ahold of MIPS support software was not quality measurement, but because they can't decipher their earning potential under MACRA.
SPH Analytics scored highest among organizations currently offering MACRA support technologies.
2. MACRA is sparking ambulatory EHR optimization
A full 83 percent of users of the eight largest EHR systems are upgrading or optimizing those systems for MIPS compliance. They can be a powerful force for collecting and submitting data. But 72 percent of the practices using EHR products not considered in the top eight largest systems -- Cerner, Epic, Allscripts, eClinicalWorks, NextGen, athenahealth, Practice Fusion and GE Healthcare -- said they weren't working with their vendor to ensure they were prepared for MIPS.
Beginning in 2018, physicians have to start using EHR technology that's certified for 2015, which could potentially burden those using small EHR vendors that don't meet that requirement.
3. MACRA consultants are a hot commodity
Of all the practices surveyed, 80 percent agreed it's essential to perform a technology inventory to see how far their EHR and other data systems can take them. Of practices with three or less physicians, 75 percent struggle to manage the technology basics, but say they can't afford paying a consultant.
4. Large practices gear up MACRA resources
Of independent physicians in practices of four or more clinicians, 81 percent say they haven't yet grasped how to align data with the reporting measures. This reveals a potentially problematic trend: MACRA requirements seem easy to meet on the surface, but as smaller practices prepare for risk, the reality will be much more difficult.
5. Outsourcing will be a last-minute MACRA play for many practices
Black Book predicts that by the end of the second quarter, many practices will be consumed by the scramble to get programs in line. Some providers haven't yet developed a plan for MACRA, and of those, 80 percent say they'll software or an outsourced vendor to catch up as best they can.
Almost a quarter of all providers, 22 percent, say they were relying on a delayed program implementation, while 91 percent who deferred technology planning are afraid they can't find trained or qualified IT workers to successfully take part in MACRA initiatives this year.
6. Even more independent physicians will be driven to sell their practices
MACRA payment model changes are motivating more physicians to shift from independent to employed status, as 75 percent of remaining independent clinicians are considering selling their practices to hospitals or group practices -- primarily to eliminate the administrative burden and capital costs.
Nearly 70 percent of respondents view MACRA as a burden, or even a bust to their independent practice by 2020. About 77 percent of hospital-affiliated physicians see the changes as an opportunity to increase revenue and improve patient care, but 66 percent report being unprepared for managing and executing MACRA initiatives without hospital, IDN or group practice support.
7. Shifting reimbursement to those with data
In 2019, the first payment year, MIPS will take approximately $199 million from eligible clinicians below the performance threshold and redistribute those funds to providers above that threshold. Eventually the redistributed money will be equivalent to 9 percent of Medicare physician payments. In addition, for the first five years, $500 million in supplemental funding will be awarded each year. During this time, MIPS adjustments could add 10 percent in addition to the maximum positive payment adjustment, which is three times the amount of the penalty.
Almost two-thirds of hospital networked physician organizations, 64 percent, are incorporating performance incentives in provider compensation models to incentivize MIPS reporting success; and 88 percent of hospitals said they're seeking ways to ensure individual performance scores are reflected in the compensation of the physicians they employ.
8. Individual physician reputations are at risk
About 54 percent of the respondents were unaware that the CMS will publish this data on their Physician Compare website, and that it will be accessible by other third party rating systems, including Yelp, Angie's List, Health Grades and Google.
Nearly 70 percent of practice managers are aware they need to report on six quality measures, yet only 22 percent knew they had the opportunity to choose the metrics they believe represent strengths to the practice.
Although essential to continuous improvement and practice success, 94 percent were unaware or unsure of how to predict their 2017 MIPS scores.
And 7 percent of practices with 15 or fewer eligible professionals have sought support with technical assistance participating in an APM or MIPS. Of those seeking assistance, 92 percent were in rural or medically underserved areas.
9. Small and rural providers are rallying for ACO inclusion
Small community hospitals and physician practices are evaluating their options in joining an accountable care organization. ACO participants can more easily achieve high scores compared to other MIPS participants, increasing their likelihood of avoiding penalties and earning an exceptional performance; MACRA requires 30 percent of the MIPS score to be based on resource utilization.
However, Track 1 ACO participants are held accountable for their cost in their ACO, not MIPS.
More than two-thirds of small practices, 67 percent, are considering joining an ACO to avoid penalties for generally lower scores due to a lack of infrastructure. And 82 percent of providers in rural areas are joining ACOs to avoid MIPS penalties due to their higher cost structure.
10. Provider cost and quality scrutiny propelled by MACRA
A previous Black Book survey revealed that 88 percent of consumers under age 44 are aware of online physician rating websites, as are 55 percent of consumers over age 45. About 12 percent of all healthcare consumers said they had viewed an online physician rating site in the past year.
Meanwhile, 52 percent of large group practices, IPAs, ACOs and IDNs say they're now starting to address, administratively, how costs in 2018 will be reported for every clinician, along with results of quality measures.