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Tracking MACRA’s Progress toward Industrywide Implementation

Since its draft implementation, healthcare experts have continued to discuss MACRA, commenting on the effect it will have on the healthcare industry and attempting to reshape it for greatest success.

By Sara Heath

Since the Centers for Medicare and Medicaid Services announced its draft implementation for the Medicare Access and CHIP Reauthorization Act (MACRA) at the end of April, there has been a flurry of industry opinions, rule clarifications, and potential revisions for the rule.

Specifically, there has been much talk about physician readiness for MACRA, with surveys suggesting providers are not well-versed enough in the law and statements from CMS about potentially pushing back the start date of the program.

Below is a round-up of the recent news surrounding MACRA and the way it will affect the healthcare industry.

Providers lack knowledge of MACRA implementation

Earlier this week, a survey from Deloitte indicated that providers are not aware of the details included in the new law, showing that about half of high-Medicare physicians know nothing about MACRA, and another 32 percent are only able to recognize the name of the law.

Further, only nine percent of employed physicians, and 21 percent of independent physicians, know of and understand the reimbursement changes embedded in the law’s Quality Payment Program.

This news is alarming, considering the vast effects MACRA will have on the healthcare industry, specifically through its shift toward pay-for-performance models. According to the survey, about 80 percent of providers prefer fee-for-service payment models and are in for a notable awakening when the law takes place in 2017.

The survey also showed provider concern about transitions to value-based payments, with several saying they are concerned about having the correct resources for such a switch.

CMS considers new MACRA start date

Considering the findings of the Deloitte survey, as well as the many industry leader calls for a pushed back start date for the law, CMS has openly discussed later implementation for MACRA.

At a meeting for the Senate Committee on Finance, CMS’s Andy Slavitt stated that the agency was open to reconsidering MACRA’s start, saying that it is important to him and CMS to ensure that providers begin this new program on a positive note.

We need to launch this program so that it begins on the right foot, and that means that everyone physician in the country needs to feel like they're set up for success. So this has been a significant source of feedback we've received as well and I would start by saying we remain open to multiple approaches. So some of the things that are on the table we're considering include alternative start dates, looking at whether shorter periods can be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them.

These comments, while not promising a later start date nor suggesting when that potential change could occur, do signal an openness for flexibility on the part of CMS. Such flexibility answers many calls from industry leaders to make MACRA more pliable to provider needs.

ONC discusses interoperability under MACRA

Federal agencies have not only been tied up with MACRA implementation dates and flexibility; they have also been working to ensure measures for certain program requirements help make the program feasible and constructive, helping to support value-based and patient-centered healthcare.

At the Office of the National Coordinator for Health IT (ONC), this has meant discussing the role interoperability will play in the program. Under the proposed implementation rule, health IT interoperability plays a critical role.

However, CMS and ONC did not clearly specify how they will measure interoperability, and instead issued a request for information asking industry stakeholders to comment on the state of interoperability under MACRA.

Just last week, ONC released a draft for how it plans to measure interoperability, including two main pillars:

  • Measure #1: Proportion of health care providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources.
  • Measure #2: Proportion of health care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.

ONC explained that these two measures were set in an effort to acknowledge the main concerns from commenters, including the issue of burden, scope of measure, care outcomes, and the complexity of measuring interoperability.

Several industry stakeholders still may not see MACRA as a perfect program. However, the attention lawmakers and healthcare experts have been granting it is indicative of its path toward improvement, eventually becoming ready for full implementation.

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