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Oncology practices face hurdles in MACRA implementation, American Society of Clinical Oncology study says

Most will have to ramp up services to meet MACRA compliance standards, need to educate themselves on law itself, ASCO says.

Jeff Lagasse, Associate Editor

Many practices will need to enhance their services and data reporting to meet all of the requirements for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, and some aren't aware of the specific reforms at all. That's according to a new study from the American Society of Clinical Oncology.

MACRA took effect in January, but its first set of rules weren't released until about a year ago, which has created challenges for physicians and health policy groups.

[Also: Providers still not ready for MACRA, Stoltenberg survey says]

Looking primarily at oncologists, the report issued by the American Society of Clinical Oncology found that while most are already using electronic health records and participating in one or more quality programs, most of them will have to ramp their services up a notch to meet the performance standards under the Merit-Based Incentive Payment System, and to qualify for positive payment adjustments in 2019.

Another potential roadblock is knowledge of MACRA itself, with many physicians unprepared to make the requisite changes. A 2016 Deloitte survey of more than 500 physicians found that a full half had never heard of the law, while 32 percent were familiar with the name and not the requirements.

[Also: Participation in Medicare Shared Savings Program bodes well for MACRA bonuses, experts say]

A majority of them also expressed opposition to the value-based measures that are fundamental to the law. A full 80 percent prefer fee-for-service models over those that are value-based, and a similar number said they don't support the use of quality metrics to determine their levels of reimbursement.

ASCO said that physicians will face a period of financial risk and uncertainty as the MACRA rules are implemented. But the shift to value-based models is already underway among commercial payers like Aetna, Anthem, United Healthcare, and Blue Cross Blue Shield. Practices are concerned about their ability to adapt to these shifts.

The move to value-based reimbursement isn't limited strictly to Medicare and commercial insurance plans. Big employers that run their own health plans, like Walmart, have also enacted steps to make the transition. A 2016 Physicians Foundation survey found that 43 percent of physicians have already begun to receive some portion of their reimbursement under value-based systems.

To make MACRA work for everyone -- payers, patients and providers -- the ASCO said the development of new payment models should allow for engagement and input from patients and providers. The group said the Centers for Medicare and Medicaid Services could support the testing of multiple models as potential Alternative Payment Models for oncology care.