MACRA –Part 2: The Critical Success Factors
Based on information in the previous blog (MACRA – Part 1:
The Realities), it is clear the “train has left the station” on the demise
of fee-for-service payments for clinical services and the growth of value-based
payment reforms. Although the actual full implementation of this transformational
program by CMS may be delayed, physician practices, that have not already
done so, must begin now to implement those changes which will make them
successful.
Clearly, all physicians should want to provide for their patients the highest
quality of care possible at the most affordable costs. But all providers
and payers realize that we are far from reaching this goal, especially
highlighted by a recent report that medical errors are now the third leading
cause of death in the United States. CMS, according to Andy Slavitt, its
acting administrator, believes that value-based payment reform has the
greatest chance of reversing this trend. In his brief article published
in the September 12, 2016 issue of
Modern
Healthcare, entitled “CMS to make MACRA less painful with ‘pick your pace’
options”, he stated “the bulls-eye for us isn’t what
will happen in 2017; it is about what will lead to the best patient care
long term”.
DRIVERS of SUCCESS
The drivers of this success perhaps are best understood by looking at two
aspects if the MACRA program and their subgroups:
- Data Submission Methodologies
- Claims Submissions
- CMS Web Interface
- EHR Data and Analysis
- Medicare Registries
- Payment Determination Criteria
- Quality Metrics – 50%
- Cost Metrics – 10%
- Total cost/capital for all beneficiaries
- Medical spending for each beneficiary
- Expense for 40 specialty specific episodes
- Care Management Programs - 25%
- Care Improvement Metrics – 15%
The critical factors for physicians’ success under MACRA include:
- Comprehensive and accurate coding and claims processing
- A robust EHR system that provides continuous data that can be analyzed
and acted upon to improve the quality and safety, care management, proactively
driving the implementation of continuous performance improvement programs
- An accurate cost-accounting system
- A value-based purchasing program
- Effective information technology support
Although the final rules for MACRA will not be published until November
of 2016, the question is not “are we sure it is going to be implemented”,
but rather “what do we, as providers, need to do to be successful?”
Each of the success factors outlined above have a clear pathway for achievement.
Each has been implemented fully and successfully in a small number of
practices across the United States, estimated to be about 8% and mostly
large practices that have a long history or are part of an integrated
system. For the solo practitioners and small practices, even CMS agrees
the journey to success will be somewhat difficult.
However, whether in small or large practices, the final critical success
factor will be the degree to which the physicians understand and embrace
this payment reform transformational journey. Every physician must be
committed to continuously improving their clinical outcomes, controlling
their costs, and improving access for their patients. With this commitment,
success in a value-based payment model might be slow in coming, but it
eventually will be achieved. Unfortunately, getting this support will
be difficult and challenging, as it usually is with any administrative
change in the healthcare industry, but especially for those that have
the potential to reduce the physicians’ incomes. This is the most
important toxic side effect of MACRA that will be discussed in Part 3
of this blog series.