MACRA: Ready or Not, Here I Come

macra begins

When Andy Slavitt, the top boss at the Centers for Medicare and Medicaid Services (CMS) indicated in mid-July that MACRA might be delayed from the proposed start date of January 1, 2017, it made headline news. However, the controversial Act is now on schedule. What is seen as an overly complicated legislation by many physicians is here to stay.

Just like the confusion surrounding the ICD-10 implementation, MACRA has had its fair share of debate. This is because MACRA will have a significant impact on Medicare reimbursement by as much as plus or minus 9 percent by the year 2023. Many organizations have delayed allocating resources to the new legislation in the hope that it will be delayed further or changed considerably. Serious concerns continue to be raised about the complexity and timing of MACRA, but in spite of the uncertainty and apprehension, the legislation will go into effect this coming New Year’s Day.

In October 2016, the CMS unveiled the nearly 2400-page final rule on MACRA. Based on public comments on the previously released proposed rule, the final rule includes simplified requirements, greater flexibility, and better support for small practices. The hope is that this will make it easier for clinicians to align with MACRA.

There is no doubt that the implementation of MACRA will bring about a sea change in healthcare reimbursement. Organizations should already have preparations underway. The new requirements of reporting quality, advancing care information, and clinical practice improvement activities have evolved from previous MU, PQRS, VBPM, and MSSP requirements. Although at the core physician competencies will remain the same, under MACRA, they will be measured differently.

To navigate MACRA successfully, healthcare organizations need to invest in financial risk modeling, better provider-patient engagement, stronger clinician leadership, and improved EHR documentation and structured reporting. Committees should prioritize initiatives to ready the practice for MACRA. A cross-functional team is needed to drive the change in the entire organization.

Consultants with experience in implementing Meaningful Use and Physician Quality Reporting System measures are best adapted to help your practice maneuver the change to MACRA. Many support tools are available to make documentation clinician-friendly. Experts in the field can help your practices develop and implement a strategy to report the measures required by MACRA. However, experience with EHR alone will not suffice. MACRA compliance requires a deep knowledge of risk management, quality assurance, and coding. Healthcare organizations must rely on analytics, methods, tools, as well as consultants with a proven record in operations management. MACRA and value-based reimbursement is here to stay. Your organization can work together with experts in the field to make the transition easier.

Contact us to find out how we can help get your claims paid.

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