I want to share with you what is ahead for us in 2017. My Alabama colleague and governor of the Alabama-ACC, Dr. Andy Miller, wrote the following piece on MACRA and gave permission to share it with you. Take a moment to read it::
MACRA. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be our biggest challenge for the next several years (or more likely for the remainder of our careers), and unfortunately we are woefully unprepared. More shocking, we are the most prepared specialty in the House of Medicine to make the legislated change from volume to value! We need a plan.
It begins January 1, and if you have not considered how you are going to make your practice a winner in the new scoring system, then you will probably lose money in 2019 and beyond (2017's performance decides 2019's payments, and so on). I suggest that you:
1. Decide who your MACRA team will be and join them in working on it now.
3. Assess your practice readiness. Look at the components of MIPS. Look at your PQRS and QRUR performance. If you are on PINNACLE, ensure that your mined EHR fields are tracking well. Use the AMA’s MACRA assessment tool (
https://apps.ama-assn.org/pme/#/). Remember MIPS is composed of 4 categories: Quality (formerly PQRS), Advancing Care Information (formerly Meaningful Use), Improvement Activities (this is new – think science fair projects), and Cost (formerly QRUR and your value-based modifier)
4. Create dashboards for your Quality measures now. Choose the ones you will report, and this might be dynamic as you go into the next year.
5. Meaningful use becomes Advancing Care Information and this is the EHR, e-prescribing and public registry portion of MIPS. Decide if you are meeting the metrics.
6. Look at the >90 clinical practice Improvement Activities and decide where you might participate.
7. Take a breather on cost/resource use this year, but it will hit us in a hurry as cost and quality will get equal importance in a few years.
8. If you do not understand items 3-7, go back to the beginning and start again.
Here are the scary facts:
1. MACRA is budget neutral. It will borrow from the lower performers to pay the higher performers. In 2017, if you report one quality measure, do one improvement activity and are up to date on meaningful use, then you will probably not lose money in 2019. After that, it’s pitting us all against each other.
2. 96% of cardiology practices will be in MIPS out of the gate in 2017. But, we will be pushed to the next step – Alternative Payment Models (APMs) – and this is where the real cost sharing occurs. MIPS is still a fee-for-service model, with a modifier for how you perform on quality, cost, computing, and CMS improvement activities. APMs require risk sharing in caring for a population. CMS would like 50% of us entering one in 2018.
Overall, I am hopeful that MACRA will force our hand to move from volume to value; however, the devil is in the details and they seem to change daily with updates from CMS. It has been difficult to define metrics that represent evidence-based, cost-effective, high quality care and that stand the test of time. In attempting to locate those variables, we have seen unintended consequences, such as risk avoidance, increased computer and reduced patient interactions, and making private practice cardiology an endangered species. If I have scared the snot out of you, register now for the CV summit in Orlando in January (http://www.ACC.org/CVSummit17).
