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10 MACRA Trends Likeliest to Challenge Eligible Clinicians

Top MACRA challenges include a need for new health IT systems for meeting MIPS requirements and EHR optimization of current systems in ambulatory care.


Source: Thinkstock

By Kate Monica

- Results from a recent Black Book survey of 8,845 surveyed physician practices identify the top ten most challenging aspects of MACRA implementation for eligible clinicians.

With the first year of MACRA implementation underway, physician practices are currently encountering challenges meeting the requirements of the Quality Payment Program — comprising the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payments Models (APMs) — designed to usher in the healthcare industry’s transition to value-based care.

The following is a list of the most significant challenges accompanying MACRA implementation according to Black Book data gathered between February and April of this year:

1. The need for new MIPS technologies

According to Black Book, 77 percent of surveyed physician practices with 3 or more clinicians are looking to buy technology solutions compliant with MIPS requirements by Q4.

READ MORE: MACRA Incentives Likely to Increase Physician Health IT Use

“Given the magnitude of the changes, the hunt is on for the best MIPS incentive enablement resources,” said Managing Partner of Black Book Research Doug Brown.

While a majority of providers are seeking health IT solutions to meet MIPS requirements, 92 percent of surveyed physician practices are not presently aware of any vendor technologies supporting all MIPS registry measures for 2017 reporting besides their EHR. 

2. Increased pressure for ambulatory EHR optimization

Eighty-three percent of surveyed users of top EHR systems report upgrading or optimizing their systems in an effort to comply with MIPS.

While EHR systems can be useful in helping practices with data aggregation and submission, 72 percent of practices stated they were not working alongside their EHR vendor to prepare for MIPS measures and reporting.

Pressures to optimize ambulatory EHR systems will only continue to mount as physicians will be required to use 2015 edition certified EHR technology (CEHRT) starting in 2018.

READ MORE: MACRA’s Quality Payment Program to Support Health IT Progress

 “The replacement market is heavily leaning to these largest 8 EHRs from small EHR vendors and expected to increase through 2018 as some providers had previously invested in EHRs that do not acclimate to agile change at scale like MACRA demands,” said Brown. “EHR companies are not required by MACRA to update their technology so providers are ill-equipped should the practice stick with their uncertified EHR.”

3. The need for MACRA consultants

According to Black Book, 80 percent of surveyed physician practices reported that performing a technology inventory is a must when it comes to ensuring their EHR and other data systems are ready for MACRA implementation.

“MACRA consultants are busy identifying and developing tools to support innovative projects as well as to bring clinicians on board as quickly as possible but hard to contract currently because of demand,” said Brown.

While 75 percent of practices with 3 or less physicians agree with their larger counterparts that a consultant is a useful asset in taking technological inventory, they report not having the resources to afford paying a consultant in 2017.

4. Hefty resource requirements

READ MORE: MACRA Raises Need for EHR Optimization, Other Improvements

Eighty-one percent of independent physician practices with 4 or more clinicians reported uncertainty regarding how their practices will align existing data with reporting measures.

“Seemingly, the MACRA requirements appear fairly easy to meet, you simply attest to at least one performance improvement activity. However, the reality will be significantly more difficult as smaller practices in particular begin preparing for risk,” said Brown.

5. Time management problems when outsourcing MACRA strategy development

Eighty percent of provider organizations without a MACRA strategy anticipate selecting a turnkey software or outsourcer to make up lost time as quickly as possible for 2017.

“It is imperative that providers grasp the requirements of MACRA now to ensure they put the right strategy in place, since the pace of the program only accelerates in 2018 and beyond,” said Brown.

Meanwhile, 22 percent of providers remain optimistic a delayed program implementation will save them from scrambling for a plan last minute.

Ninety-one percent of providers who refrained from committing to any technology planning are worried about not finding qualified IT workers to help them successfully participate in MACRA incentives in 2017.

6. More independent physicians will be forced to sell their practices

The stresses of MACRA implementation and payment model changes are driving more physicians to switch from independent to employed status. Three-quarters of surveyed independent physicians are considering selling their practices to hospitals to avoid administrative burden and added costs.

Sixty-eight percent of physicians view MACRA as a burden threatening their independent practice by 2020 while 77 percent of hospital affiliated physicians see MACRA changes as a chance to increase revenue and improve patient care.

7. Reimbursement will be funneled to clinicians with data

In 2019, the first MIPS payment year, payment adjustment penalties are expected to be severe for eligible clinicians below the performance threshold.

To incentivize MIPS reporting success and avoid significant payment penalties, 64 percent of hospital-networked physician organizations plan to use performance incentives in their practices.

8. Increased scrutiny regarding individual physician reputations

Fifty-four percent of surveyed respondents reported being previously unaware CMS intends to publish cost and quality data on their Physician Compare website as well as made accessible to Yelp, Angie’s List, Health Grades, and Google.

“As more consumers spend more out of pocket for their healthcare they are seeking much more transparency into clinical quality and the cost-value equation,” said Brown. 

9. More small and rural providers seeking ACO inclusion

Sixty-seven percent of small practices are considering joining an accountable care organization (ACO) to reduce their chances of accruing penalties for lower scores due to lack of sufficient infrastructure and resources.

Additionally, 82 percent of providers in rural areas are joining ACOs to avoid MIPS penalties deriving from higher cost structure.

10. Increased scrutiny over provider cost and quality

A Q4 Black Book survey showed 88 percent of patients below the age of 44 and 55 percent of patients over the age of 45 are aware of online physician rating websites.

Twelve percent of all healthcare consumers stated they had viewed an online physician rating site in the past year.

“In particular, hospital network physician groups are taking notice that consistently high performance scores and ratings can be a strategic advantage over local competitors,” said Brown.

To address the increasing availability of online data relating to the cost and quality of patient care, 52 percent of large group practices, IPAs, ACOs, and IDNs reported starting to administratively address how costs will be reported for every clinician along with the results of quality measures in 2018.



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