Key considerations for the coming transition

Becker's Hospital Review

 |  This article originally appeared at: Becker's Hospital Review

June 29, 2017

The transition to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is well underway for eligible clinicians (EC). At this time, clinicians should be familiarizing themselves with reporting requirements and understanding the potential impact—on both providers and patients—so they’re ready for the first submission deadline next year. Finalized in 2016 to replace the Sustainable Growth Act, MACRA was created to help sustain the Medicare system and promote long-term benefits as part of Medicare’s Quality Payment Program. In the last year, providers have been inundated with information surrounding MACRA participation and its two possible tracks—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).Choosing a track and participating in MACRA certainly requires appropriate consideration to optimize benefits for both providers and patients. However, many providers are unsure of next steps and feel overwhelmed. By turning to key resources and strategic partners, providers can successfully prepare themselves for the transition and realize the full benefits of this program.

Benefits to Providers

Although MACRA was developed to sustain the Medicare program, providers and patients will also benefit from participation. For instance, providers who choose the MIPS track report data on quality, improvement efforts, information sharing and costs to show they provided high quality, efficient care supported by technology. In turn, they are able to earn a performance-based payment adjustment to their Medicare payments.Alternatively, providers can choose to participate in the APMs track and earn incentive payments. These payment models typically apply to a specific population, clinical condition or care episode such as oncology care and knee or hip replacement, and require providers to take on additional risk that further weighs patient outcomes and costs.Regardless of which track a provider follows, positive payment adjustments first will be realized in 2019, which will help avoid the “payment cliffs”—or quick drops in reimbursement payments for clinicians—that would have occurred with the repealed Sustainable Growth Act.In addition to its impact on a provider’s bottom line, MACRA participation should help providers obtain higher ratings. These ratings can then be used to help retain existing patients while also attracting new ones.

Benefits to Patients

In today’s consumer-driven world, individuals rarely book travel or make dinner reservations without checking ratings or reviews beforehand. Similar to these industries, healthcare is increasingly following suit, especially as patients take on more out-of-pocket expenses. Having access to provider ratings and reviews will help them make better clinical and financial decisions for themselves.MACRA program participation also will help drive down costs of care for patients. They will require providers to follow additional care standards, streamline testing and “advance” information along to other providers, so critical data follows the patient and avoids duplicate testing and other unnecessary redundancies.For example, if a patient breaks his leg and an x-ray is ordered in the emergency room, that information and image will follow patient to each subsequent provider. As long as the standardized images were captured, it should eliminate the need to take additional x-rays, and save unnecessary costs and time for the patient as well as the provider.Moreover, care quality should be improved thanks to enhanced communication and information sharing between providers, in addition to better care coordination and continuity. Through improved communication channels, providers will also be able to incentivize patients to be engaged and active participants in their care—ultimately making the patient healthier.

Succeed in the MACRA Transition

In less than a year, MACRA participants will be reporting their data to Medicare. If patient care does not meet current standards, it could mean a negative payment adjustment and lower ratings for non-compliant providers. This would impact not only the provider’s bottom line beginning in 2019, but also their ability to attract new patients.While preparing for the transition, participating providers should consider these key resources:

  • Quality Payment Program website offers a wealth of information, including educational resources, webinars, fact sheets, user guides, and workbooks.
  • Certified EHR vendors will have additional resources and consultation packages to help develop a successful MACRA participation strategy. Partnering with a knowledgeable expert can help providers understand immediate benefits and successfully implement MACRA strategy.
  • CMS-approved qualified registries are also helpful resources for MIPS data submission. Smaller practices in particular may be eligible for government funded grant programs to help them walk through steps.
  • Other Participating Clinicians can also be helpful resources. They can direct fellow providers to additional tools or resources and share best practices.

Providers who take key steps now and seek help when it’s needed will have more time to develop an effective strategy and prepare for the MACRA transition. Doing so will enable them not only to optimize the financial benefits of MACRA on the business side, but also will help ensure patients receive high quality care while shouldering less costs.Sonya Bess is a government initiative specialist at Pulse, Inc.

Sonya Bess


Sonya Bess is currently the Government Initiative Specialist for Pulse. It is an exciting time in healthcare; physicians are taking on the new paradigms for standardized data-driven operational processes to support national healthcare goals. Anticipating the many changes that medical practices are facing as part of the eHealth Initiative, physicians continue to look for practical solutions to meet the ever changing demands of administrative compliance while maintaining excellent patient care. As part of a dynamic team Sonya has positioned herself as a liaison for healthcare professionals to assist in reaching these goals.