MACRA: A Glass One-Third Full

March 1st, 2017

In a recent Health Catalyst®/Peer60 survey, only 35 percent of the healthcare executives polled said their organization has a MACRA (Medicare Access and CHIP Reauthorization Act) implementation strategy and are prepared for the new value-based reimbursement model.

As explained in the survey report, MACRA consolidates and replaces a number of value-based reimbursement programs, including the Physician Quality Reporting System, Meaningful Use and the Value-Based Payment Modifier. The new program has two tracks – one for physician groups still largely operating in the fee-for-service realm called the Merit-Based Incentive Payment System (or MIPS), and one for those practices with the bulk of their business in alternative payment models (APMs).

Most practices won’t meet the high bar the Centers for Medicare and Medicaid Services (CMS) has set for the APM track, the report noted, and instead will be subject to MIPS rules, which offer the opportunity to earn up to an extra 4 percent (or lose up to 4 percent) on its reimbursement rates in 2019 (based on 2017 performance). The “carrots and sticks” ramp up to a potential 9 percent gain or loss by 2022. In October, CMS issued the final rule on MACRA, making it easier to comply with minimal, partial reporting in the first year.

The progress survey presents some interesting information, but what stood out for us were the primary concerns the executives listed, which involved the compiling of metrics for regulatory reporting and, to a lesser degree, adjusting to greater coordination between providers and patients.

We hope the omission of the potential impact on revenue cycle operations means that all systems are go for those departments. On the other hand, it could signify that this necessary component isn’t on the radar, as we’ve suggested previously, pushed aside by the focus on quality reporting and cost reduction.

As most providers have indicated their intent to participate in the program, we continue to urge organizations to:

  • Assess their coding to ensure their current documentation and coding processes accurately reflect the care provided.
  • Ensure coders have mastered and are consistently applying ICD-10, inclusive of recently added diagnoses codes.
  • Immediately implement any needed clinical documentation improvement and coding education.

It sounds self-serving, we know; but we also know – and respect – the importance of coding and documentation, and will continue to wave their banner as healthcare continues to evolve.