A new Health Catalyst/Peer60 survey reveals varying degrees of readiness among health systems for upcoming Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reporting requirements as only 35 percent of hospital executives report having a strategy in place and are ready to comply with MACRA reporting.
The survey findings indicate that many health systems are holding back from implementing comprehensive strategies to comply with MACRA, which will use 2017 as its first reporting year. And, according to the survey results, many health systems have hit the pause button on MACRA due to a combination of factors, including its complexity, the newness of the final rule, and uncertainty about whether the new Administration will make further changes.
The survey also examined health system executives’ top concerns for participating in MACRA and the survey findings indicate that the heavy lifting required to track and compile MACRA measures for reporting to Medicare is top of mind for healthcare executives.
For the survey, Health Catalyst, a Salt Lake City-based data warehousing and analytics firm, and Peer60, a market research firm also based in Utah, polled 187 healthcare professionals in an online survey in late 2016. The respondents included 37 CEOs and 94 other C-Suite executives, including chief financial officers (CFOs), chief information officers (CIOs), chief medical officers (CMOs), and chief medical information officers (CMIOs). And, according to Health Catalyst, the respondents work for organizations ranging from some of the nation’s largest urban academic medical centers and integrated delivery networks to small, rural critical access facilities.
In early October, the Department of Health & Human Services (HHS) finalized the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Final Rule, in which eligible Medicare physicians will be paid for the quality of care they deliver, via the government’s Quality Payment Program, which replaces the Sustainable Growth Rate (SGR) for physician reimbursement. As previously reported by Healthcare Informatics, the Final Rule, released publicly on Oct. 14, and nearly 2,400 pages in length, aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs. The new program has two tracks—one for physician groups still largely operating in the fee-for-service (FFS) realm, called the Merit-Based Incentive Payment System (MIPS) and those practices with the bulk of their business in alternative payment models (APMs).
Passed with overwhelming bipartisan support in Congress, MACRA requires physicians who participate in its financial incentives to report on a subset of 271 quality measures. MACRA consolidates and replaces a number of value-based reimbursement programs, including the Physician Quality Reporting System (PQRS), Meaningful Use, and the Value-Based Payment Modifier (VBPM).
The survey examined progress on MACRA strategies, and, as noted above, only 65 out of 187 respondents to the survey (35 percent) said “we have a strategy and are well on our way to being ready” for upcoming MACRA reporting. Whether they ready or not, most hospitals do expect to participate in MACRA, with only 5 percent of those surveyed planning to opt out of participating in the program entirely, according to the survey. “Most of those who will give MACRA a pass are doing so because they do not have sufficient Medicare charges to make the program worthwhile—for instance, physicians working with pediatric hospitals,” the study authors stated.
One surprising finding from the Health Catalyst/Peer 60 survey was that progress on MACRA strategies seems slightly higher among small-and medium-sized hospitals, despite their relative lack of resources compared to large hospitals and health systems. Respondents who said they have a MACRA strategy for their employed providers but haven’t made much progress implementing it included just 26 percent (31) of small- and medium-sized hospitals compared to 33 percent (22) of large hospitals and health systems.
The number of respondents who reported they would participate in MACRA but currently have no strategy included 33 percent (39) of small- and medium-sized hospitals and 24 percent (16) of large hospitals and health systems. “The reasons for a lack of strategy were varied, with the most common reason being that the organization was trying to figure out if providers could profit by participating in MACRA. Others said the work was too cumbersome, or they either had too little information on MACRA or they were overwhelmed with too much information,” the survey authors wrote.
When asked which MACRA-related activities “pose the greatest difficulties for healthcare organizations,” 40 percent (74 out of the 187 respondents) ranked “compiling metrics for regulatory reporting” as the biggest challenge. The next biggest challenge identified by survey respondents—18 percent—was the problem of “adjusting to greater coordination between providers and patients.”
The survey findings also indicate that, despite relatively slow movement on MACRA, there is little concern about the potential to face penalties from the federal government. “Two-thirds of the 73 small- and medium-sized hospital respondents that reported having a MACRA strategy expect their employed physicians will either receive a bonus or break even, whether or not they have made progress on their strategy. Only one small hospital respondent said providers expected to receive a penalty, while nine said they weren’t sure,” the survey authors wrote.
The numbers were similar for large hospitals and health systems. “Of the 45 respondents from large hospitals and health systems who said they have a MACRA strategy, 36 percent (16) expected their affiliated physicians to earn a bonus while 31 percent (14) said they expected physicians to break even. Just one large hospital expected their physicians to receive a penalty, while seven weren’t sure whether they would benefit or not,” the survey authors wrote.
In complex organizations, successfully achieving performance targets and submitting accurately for MACRA incentives will require integrating multiple measures across financial, regulatory and quality departments. In a related announcement with the survey findings, Health Catalyst has released its MACRA Measures & Insights application, with the aim of helping to identify and align healthcare organizations’ selection of the MACRA quality measures.
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