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Specialty Practices Not Ready for MACRA, Survey Finds

September 6, 2017
by Rajiv Leventhal
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Respondents are not making the necessary investments to be successful under MACRA

One hundred percent of specialty physicians indicated that they have not yet fully grasped MACRA’s impact on their practices, according to a recent survey from West Palm Beach, Fla.-based vendor Integra Connect.

The survey found that a growing number of specialty physicians—mostly oncologists and urologists—recognize that clinical, financial and operational changes are needed to be successful under value-based care reimbursement models stemming from MACRA (the Medicare Access and CHIP Reauthorization Act) regulations. However, the majority have not yet invested in organizational, IT, or service improvements to achieve them. 

In fact, the findings revealed that 100 percent of survey respondents indicated they have not yet fully grasped MACRA’s impact on their practices, with the most common description of their awareness as, “I am learning but have a way to go” (71 percent). Furthermore, 56 percent said they are aiming to deliver cost savings under MACRA through practice transformation to avoid unnecessary hospital stays and ER use, yet nearly two-thirds are either not prepared at all (24 percent) or are taking a “do-it-yourself” approach (40 percent) limited to their existing resources and tools.

For the survey, Integra Connect polled attendees at its June 2017 meeting in Atlanta. The respondents’ practices represent about 800 physicians—58 percent of which were from oncology practices and 42 percent from urology practices.

According to Integra Connect officials, the findings indicate that “while specialty practices understand that MACRA presents a substantial clinical and financial opportunity, few are well-positioned to realize optimal benefits, due to unpreparedness and limited investment in capabilities to manage attributed patient populations holistically and deliver both cost and quality improvements.”

Additional findings include:

  • The top three barriers to MIPS (the Merit-based incentive Payment System) success cited include: having the right people/skills (23 percent), understanding the requirements (20 percent), and cultural shift required to assume accountability for patients (19 percent);
  • Specialty practices have identified new investment areas to overcome these barriers including consulting services (25 percent), new care coordination resources (23 percent), and new EHRs (21 percent);
  • But, 62 percent of respondents either don’t know how, or have no plans, to fund these new upfront investments to enable MIPS success;

Finally, 51 percent of respondents believe their current EHR is not prepared for value-based care, including APMs (alternative payment models) such as the Oncology Care Model, MIPS, and other bundled payment programs.

“The data shows that an increasing number of specialty physicians are realizing that the transition to more holistic management of patients in support of MACRA will require fundamental changes. The challenge is that few are taking the necessary actions to ensure success,” said Charles Saunders, M.D., CEO of Integra Connect, said in a statement. “To maximize clinical and financial returns under MACRA, these practices will need a combination of comprehensive technology designed for their needs, process improvements and dramatic cultural change with new skillsets such as care management and navigation at the core.”

This survey is far from the first that has revealed low levels of MACRA familiarly on the part of clinicians. Nonetheless, October 2 is the deadline for eligible clinicians to send in MACRA/MIPS data for the 2017 program year. In June, the government released a proposed rule that would make changes in the second year of MACRA’s Quality Payment Program (QPP). A final rule is expected this fall.

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