MACRA—What IS it?

Believe it or not, many organizations and individuals still don’t know or aren’t aware of the following facts about MACRA. Do you know that:

1. MACRA has already begun and the full implementation, including payment adjustments, is set for January of 2019.
2. MACRA’s quality payment programs (QPPs) are the first of many value-based reimbursement (VBR) programs and are being rolled out by CMS and commercial payers.
3. Succeeding under MACRA and other VBRs will require a deep re-tooling of both the payment model and the clinical care delivery system.
4. The four performance categories measured under MIPS can be effectively combined into initiatives that move the dial toward improving metrics within all categories.
5. Past performance in the physician quality reporting system (PQRS) and the value payment modifier (VPM) programs can be used to design a roadmap for future success under MACRA.
6. MACRA uses a risk-adjustment methodology to allow for fair comparison of quality and cost data between providers. This risk-adjustment method relies on the capture and addressing of hierarchical clinical conditions (HCC) by providers.
7. Capturing and addressing HCCs requires a systematic approach to risk adjustment coding that most organizations don’t have in place.
8. MACRA attributes patients via the same methodology that was used with PQRS, where many specialists found themselves responsible for quality measures, e.g., mammograms or immunizations, that they assumed were the responsibility of primary care physicians.
9. There have been many changes to MACRA since it first passed in 2015. These changes effect who must mandatorily participate, how reporting is done under MACRA, and how small practices, non-patient facing providers, and rural practices receive special treatment under MACRA.
10. Reporting MACRA performance measures can be done in a variety of ways and should be customized to the needs and resources available at each practice or other institution participating in this program.

If you are a healthcare provider who needs to know more about this groundbreaking CMS payment model, let us at Coker Group know.