February 07 2017 | 0 Comments | 215 reads Average Rating: 4.4

MACRA: Proceed at Your Own Pace – But You Might Want to Hurry

by Dr. Kevin Keck in Health Analytics

Providers breathed a sigh of relief when the final Medicare Access and CHIP Reauthorization Act (MACRA) regulations were released in October. The rules are part of the government’s Quality Payment Program, which healthcare providers can participate in through either the Merit-based Incentive Payment System (MIPS) or through Advanced Alternative Payment Models (APMs). Instead of providing an inflexible course of action, the regulations allow providers to move toward and adopt data collection and analysis practices at their own pace. The catch: those organizations that want gold medal results are likely to realize that the quicker they dive in and fully embrace data analytics, the better. A look at the five options that providers are currently facing reveals why it might be better to start participating sooner, rather than later:

1) Stay on deck. Organizations that refuse to jump in – and don’t submit any 2017 data – will realize a four percent reduction in payments.

2) Put your toes in the water. Organizations that simply test the MIPS portion of the system – and submit a minimal amount of data such as one quality measure or improvement activity during 2017 – can avoid penalties and maintain the status quo.

3) Jump in when you’re ready. Providers can participate in MIPS under a partial year option. Under this option, providers that submit 90 days of data at any time between January 1 and October 2, 2017 could become eligible for a small payment adjustment.

4) Dive in head first. Providers that are ready to go on January 1, 2017, can submit quality data for a full year will be eligible for up to a 4 percent boost in 2019. As the program progresses, the positive/negative adjustments increase: +/- 5 percent in 2020, +/- 7 percent in 2021, and +/- 9 percent in 2022. All adjustments will be applied two years after the corresponding performance period.

5) Take a Phelps-like approach. Provider organizations can go all out and choose to participate fully in an Advanced Alternative Payment Model (APM). These organizations will be eligible for a 5 percent incentive payment in 2019. Providers participating in the APMs could start off with a 5 percent positive adjustment for the 2017 performance year if they receive 25 percent of their Medicare payments or 20 percent of their patients through one of the risk-sharing models.

While the regulations provide options, there’s one underlying current: No matter how a provider chooses to jump in to the MACRA mix, they are all required to collect and aggregate various types of data. As a result, big data and population health management capabilities will eventually come into play for all providers. So, while some providers might choose to tread water for some time, they need to eventually leverage data that will enable them to get a full view of the patient and use analytics to improve quality. Indeed, providers who want to qualify for any of the positive payment adjustment levels will need to invest in the technologies that enable them to improve care coordination and population health management.

What technologies will your organization be likely to consider as you seek to succeed under the MACRA regulations?

This article was previously published on Dr. Kevin Keck’s Linkedin channel.

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Author
Dr. Kevin Keck
Chief Medical Officer

Dr. Keck is SCIO’s Chief Medical Officer and leads the Clinical Analytics development team. His responsibilities include assessing the leakage and the impact of quality and cost in Provider Analytics.

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