The requirements under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) present a set of challenges and opportunities for hospital and health system leaders, as they work with their affiliated and employed physicians to fulfill the requirements of the law’s two different components: the MIPS (Merit-based Incentive Payment System) program and the APM (alternative payment model) program, the opening keynote speaker told attendees on Thursday at the Health IT Summit in Cleveland, being held at the Hilton Cleveland Downtown.
Robert Schwartz, M.D., a principal with The Chartis Group, in the Chicago-based consulting firm’s information and technology practice, gave the opening keynote, under the title “MACRA: The Latest Accelerant to Value-Based Care: Are You Ready?” Dr. Schwartz portrayed for his listeners a rapidly changing U.S. healthcare landscape, one in which the leaders of patient care organizations need to move forward, and help their physicians move forward, to meet new payment-based realities.
Among the several new realities, Schwartz told his audience, is that “The cost pressures on us will get worse” going forward, “so it behooves us to become more cost-efficient going forward. We should be reimbursed for doing the right thing, for taking care of patients well, and for having good fiduciary responsibility while doing that. And a rise in healthcare consumerism is a good thing,” he added. “We have to figure out how to get patients involved and keep them involved, while maintaining the professionalism of care.”
Given the emerging landscape, particularly around MACRA, Schwartz told his audience that patient care organization leaders need to focus on five key operational areas: provider network assessment; performance optimization; revenue optimization; payer portfolio analysis; and consumer engagement strategies. With regard to performance optimization specifically, he said that “What MACRA is going to drive is a continuous imperative for us to continually improve what we do.”
Robert Schwartz, M.D.
What’s more, Schwartz said, “We are seeing that the post-election milieu is going to align with the same things that MACRA is going to push us into,” in terms of payment-driven cost-control mandates and mechanisms. As a result, he said, “Things are going to accelerate a bit now,” particularly as the passage of MACRA has meant the combining of several previously disparate measurement systems into one, under MIPS. “We’re seeing the government say, let us have a single goal, a single direction in which to go. That’s the good part,” he said. On the other hand, whether or not the consolidation of different outcomes measurement systems around physician practice, will lead to a lessening of burdens for practicing physicians, “I believe the jury is still out as to whether it will do that or not.”
Schwartz cited several critical success factors that he believes will be needed for physicians to succeed under MACRA. First, he said, “Time is of the essence: if you’re not already doing the things I’m talking about, you’re behind the curve. This is really intimidating,” he conceded, as the work needed to fully implement processes to be successful under the law will be challenging and take time. Within that, he said, “Quality--as it should be—is paramount. It has to be delivered, documented, analyzed, tweaked, and improved.”
Very importantly, Schwartz told his audience, “You must have a MACRA strategy. This is not the time, as I’ve seen in the past, where we take a metric, a regulation, a purpose, an event, and just direct a limited amount of resources to accomplish it. The thing that really comes to my mind,” he said, “is the example of how we took the metric under the meaningful use program, of the requirement to create a patient portal, and a lot of patient care organizations put in patient portals in order to check that box for that program, but haven’t really to a great extent leveraged that tool to improve patient care.” With MACRA, he said, that not an option. The level and scope of all the requirements under MACRA mean that the efforts that patient care organization leaders make need to be focused on capabilities that will help their physicians become successful under either the MIPS program or alternative payment models, in very concrete ways.
What’s more, when it comes to the data and information technology aspects of all this, Schwartz said, “I have not been in a conversation with a health system or client organization that has been successful so far around this, without recognizing how important IT is” to success under changing payment mandates, including MACRA.
How quickly will MDs move into APMs?
Schwartz spent some time speculating on the two tracks that physicians can pursue under MACRA—participating in the MIPS program, or participating in an advanced payment model (APM). “There are 600,000 physicians who are in the MIPS track this year, CMS [the federal Centers for Medicare and Medicaid Services] is estimating, and 100,000 in the APM track,” he said. “The number participating in the APM track is expected to double in the next year. But in order to participate in an APM under MACRA at this time, you have to already have 20 percent of your patients and 25 percent of your Medicare revenues already under some risk contract, in order to join an APM at this time.”
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