David Barbe, M.D., president of the AMA, speaks to the challenges and opportunities inherent in MD reporting requirements under MACRA
Developments continue to emerge around the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law, including around its two broad component programs, the MIPS (Merit-based Incentive Payment System) and APM (advanced payment model) sections of the overall program, administered by the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS).
Indeed, the June 20 release of the proposed rule for MACRA’s Quality Payment Program (QPP) for 2018 led to yet another wave of provider reactions and discussion—understandably so, given how important the QPP’s provisions will be, going forward.
It is in that context that virtually all of the major national healthcare professional associations have been actively involved in advocating for some form of optimization of the outcomes measure reporting process under MACRA/MIPS. Certainly, the American Medical Association (AMA; based in Chicago and in Washington, D.C.) has been very prominently involved in advocating for the streamlining and optimization of the reporting processes under MACRA, including under MIPS and under the APMs.
Recently, AMA president David Barbe, M.D. spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about this subject. Dr. Barbe, a practicing family physician who lives and practices in the southern Missouri town of Mountain Grove, began serving his one-year term as elected president of the association in June. He leads and represents an association with 240,000 practicing-physician members nationwide. Below are excerpts from their recent interview.
With regard to the MACRA law and its MIPS and APM components, and in particular, with regard to the quality reporting measures involved in the QPP, where is the AMA right now in terms of its policy position?
We welcome the transition from the old legacy programs into the new more coordinated MIPS program. We appreciate that the number of measurements is fewer, that there is an opportunity for them to be more relevant to physicians and practices; and we appreciate the cooperativeness of CMS in making it easier for physicians to successfully transition into the program.
David Barbe, M.D.
Many physicians in practice are expressing that they’re feeling a growing burden from all the reporting requirements. What is your perspective on that broad complaint?
We absolutely recognize that, and that’s why the AMA has worked so hard to simplify the reporting in any way we can—the number of measures, and the whole issue of the Pick your Pace program—one patient, one measure, no penalty, this year. So if the physician needs more time to figure out how he or she is going to participate more fully, this gives them more breathing. room. We’re working to make the [QPP] measures more relevant; we also believe that shorter periods of more like 90 days, are adequate, and probably a 365-day reporting period probably isn’t necessary. And, outside the rules and regs as such, we need data to be able to be captured more automated way through the EHR [electronic health record]. Manual recovery of data elements doesn’t make much sense in this day and age. So we’re working with the EHR vendors and other developers to reduce the reporting burden.
What can CIOs, CMIOs, and other healthcare IT leaders in patient care organizations, do, to support physicians in practice around the reporting requirements and challenges?
That group is responsible for the infrastructure in hospitals and health systems, and they can play a critical role in helping physicians have the IT tools they need to do what we’ve just described, capture these data elements in an automated way rather than as a single activity. We encourage them to talk to their doctors, to the frontline physicians, and ask them what they need. What’s more, the AMA put out a white paper detailing nine changes the EHR sector can do to make things easier and better for physicians. That looks a little bit beyond what the local CIO can do, but the CIOs will be a significant voice in discussions with the EHR community. And they’re the ones who can say to the vendors, these products aren’t working yet for our doctors. So they have a critical role in this, and I encourage them to work with the medical community.
And could you speak to the role of CMIOs specifically also?
I’m practicing in a large health system myself, and we wrestle with, how do the CMIOs get the sense of what the practicing physicians are feeling? I encourage them to set up a structured format of listening sessions, ways to get feedback from their practicing physicians. I encourage them to become familiar with the tools and comments that organizations like the AMA are making. They need to avail themselves of the very robust information that we’ve collected, and studies we’ve done, and to supplement that with the physicians-on-the-ground feedback, and with useful data from their own systems. That would be a powerful combination.
Is there a legitimate concern over physicians potentially becoming overwhelmed by all of this? Physician burnout is being talked about more and more now.