Exec recommends education, diligence in MACRA preparation

Elizabeth Mitchell, president/CEO -- Network for Regional Healthcare Improvement

MACRA is coming, and for any practice -- but particularly for rural practices -- it's best to get prepared now.

Elizabeth Mitchell, president and CEO of the Network for Regional Healthcare Improvement, delivered the strong message at Thursday's Maine Health Management Coalition Conference in Portland.

MACRA makes three important changes to how Medicare pays those who deliver care to Medicare beneficiaries. These changes create the Quality Payment Program, ending the Sustainable Growth Rate formula for determining Medicare payments for healthcare providers' services; they create a new framework for rewarding healthcare providers for giving better care, not just more care; and they combine the existing reporting programs into one new system.

These proposed changes replace a patchwork system of Medicare reporting programs with a flexible system that allows organizations to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models.

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MIPS allows for practices to essentially pick their own pace, determining what data to submit in 2017 in order to avoid penalties in 2019. According to Mitchell, that's a boon to those who may be scrambling to get prepared; practices get to pick their measures, and will be subsequently rated based on those measures.

"It would be really hard to get a penalty from MIPS right now," said Mitchell. "If you submit one piece of data right now, you will avoid the penalties. There are more aggressive options if you do more."

The transition year is built into MIPS, which Mitchell expects will lessen the impact to smaller rural practices. MIPS is expected to apply to about to 60 percent of all clinicians within the first year.

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Meanwhile, about 70-120,000 clinicians are expected to qualify for APMs. The Centers for Medicare and Medicaid Services have posted a list of 2017 APMs, and it will expand on that list for 2018. Mitchell said APMs will entail downside risks on the part of practices. Mitchell advocated for more advanced APO models since the ones proposed by CMS are "less than ideal."

Also, data and effective management thereof will be critical, said Mitchell. Standardizing the methodologies and metrics used should help smooth the way.

These steps are not just advisable, she said. They're inevitable.

"MACRA is not going away," said Mitchell. "It doesn't matter how much you don't like it. It's never going away."

Twitter: @JELagasse