For the 14th episode of our Monday Morning Healthcare IT Podcast Series, Tom sits down with MACRA expert Shaila Kapur. Tom and Shaila will be discussing what MACRA is, how organizations should prepare for it, some benefits of MACRA, and why third-party assistance can be so beneficial to your organization's MACRA compliance.
In case you missed it, make sure you check out last week's episode, where HCI's Scott Jacobs went over how organizations can prepare for Epic Community Connect, the role of leadership in outreach programs like Community Connect, and how to market your Community Connect program.
Tom: Hello and welcome to the 14th episode of our Monday Morning Healthcare IT Podcast Series. My name is Tom Letro, and today I will be joined by MACRA expert Shaila Kapur. Shaila and I will be going over what MACRA is, why it is important to know what MACRA will mean for you, and ways to make sure you get nothing but positive outcomes from MACRA. Thanks for being here today, Shaila.
Shaila: Thanks for having me.
Tom: Absolutely, now Shaila, our conversation today is going to center around MACRA, so would you mind starting us off by going into a bit of detail on what MACRA is?
What is MACRA?
Shaila: Yeah, absolutely. So MACRA is, the long-form name is the Medicare Access and CHIP Reauthorization Act, lots of acronyms here, so we’ll be going through all of them. But it’s a list of regulations from the Centers of Medicaid and Medicare Services, also known as CMS, and what it does, is it requires a different set of measures from clinicians to see Medicare patients. And based on the different set of measures, it changes the way that Part B reimbursement, or kind of office-related visit reimbursement happens from CMS to the clinicians. So it’s a change in the way that physicians get paid from Medicare for seeing Medicare patients
Tom: Ok, and you said it’s a change in the way that physicians get paid, but how else is MACRA different from the previous model?
Shaila: Well, earlier there was a whole set of different measures that were tracked, it was, as some people may recall, that they were reporting on measures of PQRS, Meaningful use, value-based payment modifier. It consolidates all of those measures into one program, and the clinicians now have the option to report around two lines within MACRA, one is called MIPS and one is called APM, so more acronyms. MIPS is Merit-Based Incentive Payment System, and that’s what is widely believed most physicians will be using, more of the medicine-related people will probably be using MIPS, but the second option, for more of the larger organizations, like patient or medical homes, is alternative payment models. And that is for organizations that carry more risks, as well as have the options for greater reward.
Why is MACRA Such a Priority?
Tom: Ok, and why should healthcare organizations be making it a priority to prepare for some of the possible implications of MACRA? Or maybe, what are some of the possible implications of MACRA?
Shaila: Yeah, so a couple of reasons. One is that there will be an actual financial impact, which is something that everyone would be concerned about. There will potentially be either penalties for not doing the right filing, or not having the right measures, or there could be reduced payment for noncompliance. And this reduced payment for noncompliance starts, it already started this year, because the rule is effective 1/1/17, and organizations will see the impact of that reduced payment in 2019. The plan is actually budget-neutral, so the top 25% will get bonus payments, and the bottom 25% will get penalties, so that’s the first reason, is there’s financial impact.
But the second reason really is that a number of payers, health insurance companies, are aligning the payment models to value-based reimbursement. As this trend continues of paying more for value and less for volume, payers are quickly jumping on board, because they need to build their efficiency, they are looking for ways to pay for provider efficiency, so this is going to be kind of a trend of the future, not just for CMS, but also for payers.
And then the third reason is that there’s also talk about the direction of all of healthcare is taking. So Medicare is first, most volume obviously happens around Medicare, but there’s certainly discussion of the direction that is going to be true for, not just Medicare, but all of healthcare in the future, so it’s best to get prepared.
Tom: Right, and how can organizations learn what MACRA will mean for them, or what can they do to get prepared?
Shaila: Well there’s a number of things, of course CMS has a list of all the regulations online. There’s, you know, more than you could possibly even read about the different types of regulations. But many clinicians don’t have the bandwidth or the focus to necessarily absorb all of that, so many physicians are turning to consulting companies, especially those they already know, that they’ve worked with in the past, are needing help to be able to figure out “What does MACRA mean?” And then secondly, “What’s the potential impact to me?” Both in terms of penalties or negative payments, but also in terms of upside, that if I were to comply with this, and be able to fill in these kinds of end reports and these measures, what would I really gain?
And then the third piece of it is to really understand what my MACRA strategy should be, based on what I see my Medicare patients doing, the direction that I want to see my organization or my practice head in, how do I want to develop a MACRA strategy? How does that fit with the rest of the strategy or vision of my organization? And then, lastly, I think everyone is going to need a lot of help with “How do we actually craft these measures and report on them?” Because the measures are fairly comprehensive, and new, they can be onerous to start off with. There’s different types of reporting, there’s different types of technological needs for it, so many times they’ll need outside help in order to comply with this.
Outside Assistance with MACRA
Tom: Ok, and would you even go so far as to say that outside help from resources would be necessary? Or would it be possible for organizations to successfully align with MACRA without any kind of outside help?
Shaila: Yeah, great point Tom. I really think that downstairs, some larger organizations with patients in medical homes or affordable care organizations could potentially have the resources to put some expertise around this, and really be able to study and understand what the implications are. But I think, other than the largest organizations, that most are really run like a business. Most organizations are going to need some outside help, because this isn’t what they do. Although there is a lot of direction that says we want to head more towards value, many clinicians and many other organizations are really focused on healing, and less focused on “How do we operate as a business?” So making that transition happen, from what we do today to what we need to do in the future to really get the full value of our reimbursement and potentially our incentives, I think almost everyone is going to need some outside help.
Tom: Ok, and with the knowledge that MACRA has already gone into effect as of the first of the year, who should organizations be looking for when it comes to finding help figuring out what it will mean for them?
Shaila: So I think the first thing they should be looking for is organizations that know something, that have some expertise in this, because it is complicated and there is a lot to digest. But I would say they should also look at consulting firms that have technology capabilities, especially in the direction of an Electronic Health Record, because there will be a certain amount of requirements and reliance on an Electronic Health Record and technology to make this kind of reporting happen. And technology, overall, can be good for just this ability to gather all this data together and report on it. So looking at firms that have EHR and technology capabilities, as well as the expertise on MACRA strategy and development, is key. The other thing I would look for as someone buying these services, is looking for firms who can really help you understand it, who can speak my language, and be able to really have a focus on training and education. Not just me as a clinician, but also all the people in my office who are going to be affected by this, who are going to actually be gathering the information, to explain to them the importance of it, the value of it, and implement new processes potentially, to be able to report on these new measures. So I’m going to be looking for a firm who not only does technology, but a firm who also has a good understand of how to bring education, and bring simplification to this complicated process.
Benefits of MACRA
Tom: Ok, and what are some of the benefits of MACRA as opposed to the older model?
Shaila: Yeah, good question, because I think a lot of times people are going to be thinking “Why do we have to make this change?” It was hard enough to begin with, but there are really some benefits that I think may not be as obvious. The first thing is that the desk information is more controlled, so even though there are a number of new measures and new categories that have to be reported in, the clinicians at this point and with this system have more options and more potential benefits from their data. For example, in some of the four categories that are in this, the organizations or clinicians can actually have the opportunity to select measures themselves. And that means that they can pick the measures that are not only strong for them, but the ones that they potentially have the greatest opportunity to improve. So that’s why strategy is such a key piece of this, to be able to understand, you know, where is my practice headed, what are the types of skills I have, and where are the areas that I really want to make improvement? And those can be, those interception points can really help select the best measures where we have the opportunity to select measures and report on them.
But the real best of MACRA, I think in many ways, is the actual data that comes with it. So there is a lot of emphasis here, I believe, on the greater storage and more data. And what is the potential opportunity with that? With actionable data, in theory, clinicians should be able to better predict what the next patient will experience, and therefore have a better outcome at reduced costs. So the real value of this is that there will be more data, there will be data sharing in terms of comparing physicians to each other under MACRA, and that will give potentially again, the opportunity that with the more data you have, you could predict better health outcomes, which is truly the value, or the objective, behind MACRA, is to get better wellness and better outcome. So sometimes in the face of all of this changing and data, and why do I have to do this differently, some of the benefits can be lost. But there are two benefits that should have a positive impact on the wellness of a clinician’s population.
Tom: Ok, and even though the emphasis of MACRA is shifting the focus from quantity of care to quality of care, many physicians and organizations are worried about it. Why is that?
Shaila: Well the biggest thing, and this reflects some of the clinicians I have talked to as well, many of them say “It’s just too hard for me.” When you first read it, honestly it is very complicated and very new, and it is, which is why we need help. But many of the physicians are saying my job is to heal patients, I am not a businessperson. I don’t have the bandwidth, I don’t even have the interest to be able to understand, absorb, and change my processes. So I think the complexity of MACRA is very potentially intimidating to people. In addition, technology is another key component of people to an electronic health record, but it does require a certain level of technology capability, in order to report under MACRA. And then, people are also concerned about “How is this going to change my organization? What’s the impact to money that I’m making, what’s the impact to the dollars and cents of my business? Do I have to hire more resources to do this? Am I going to have to change my bottom line?” So the complexity, technology, changes from organization to additional resources are all things that are potentially causing people to turn a blind eye to this great opportunity, an opportunity that is not going to go away.
Advice for Organizations With Regards to MACRA
Tom: Ok, and last question here Shaila, what would your advice be to organizations trying to comply with new alignments from MACRA?
Shaila: Yeah, I think the first thing that organizations should do is first try to decide what MACRA is, so cut beyond pages and pages of CMS-related online information, and get a really crisp view of what MACRA is, which is something that there are many resources that can do that very effectively and crisply. And the second thing then is to understand “What is the impact to me? What is my potential penalty to not complying, if I just don’t do anything? And what is my potential upside if I do something? And the third thing I would go to is to say “What do I need to do in my organization, and is this something that fits strategically into my vision, and something that I feel that I have the resources to do, or do I know what I have to do in order to incorporate these changes. So all of these things I’ve mentioned, kind of looking at what MACRA means, looking at what the potential dollar and cents impact is, and thirdly, what is the impact of being able to comply with it, are not things that are that difficult to do. With the right resources, these are things that can not take weeks, but just days. And if you get the right resource involved in trying to look at this quickly, you can potentially really have a great financial impact from it, and the sooner the better, because as you mentioned, this is already in effect.
Tom: And if you are looking for qualified, knowledgeable resources to assist you while your organization prepares for MACRA, look no further than The HCI Group, as we already have an established methodology that can make the transition to MACRA compliance a seamless process, but thank you Shaila, that is all the time we have here today.
Shaila: Ok, thank you Tom!
Tom: Absolutely. For more information on what MACRA is and how to make sure your organization is ready for it, feel free to subscribe to our blog and our podcast, and to follow us on social media. Also, make sure to comment below with any questions, concerns, or things we may have missed, so that we can keep the conversation going. For Shaila Kapur this has been Tom Letro of The HCI Group. The HCI Group, offering a smarter approach to Healthcare IT.