MACRA is coming and many providers are not ready for it. The problem is particularly acute among small and solo medical practices where financial constraints, more limited resources and lack IT expertise make transitioning to the new value-based payment model more difficult.
In a recent survey of more than 2,000 providers by Healthcare Informatics, 80% of practices with 15 physicians or fewer said they were not ready for MACRA or needed help, versus 54% of practices with 100 or more physicians.
The Centers for Medicare and Medicaid Services (CMS) has committed $100 million over five years to assist smaller practices in meeting MACRA requirements, but that may not suffice. “It is critical that providers have a clear grasp and roadmap for where the CMS is moving provider payments so they can start adjusting their workflows and begin acquiring the tools and resources they will need,” Arien Malec, vice president of data platform and acquisition tools at RelayHealth, told Healthcare Dive in September.
A key part of MACRA is the performance indicators, answering questions and inputting information to generate metrics that measure an organization’s compliance with the regulatory requirements. Set to take effect two years from now, the value-based payment paradigm will get rid of the sustained growth formula and replace it with a .5% annual rate increase until 2019 when physicians will be expected to move to either the Merit-Based Incentive Payment System (MIPS) or an alternative payment model (APM).
Challenges facing small and solo practices
The payment adjustment formula is complicated, and with the CMS offering several pathways for MIPS and APMs, there’s a lot of room for confusion, Dr. Michael Hyder, executive vice president of healthcare delivery at Optimum Healthcare IT, told Healthcare Dive.
“It can be challenging for physicians in small practices to determine their next steps.”
Dr. Michael Hyder
Executive vice president of healthcare delivery, Optimum Healthcare IT
Lack of resources and expertise also make it harder to promote value-based care in areas such as patient quality and safety management, care management, data analytics and team-based care models like a patient-centered medical home, Hyder added.
Behind that are requirements that call for additional technical capabilities such as the ability to electronically exchange patient information beyond the four walls of a practice, Gary Palgon, vice president for healthcare and life sciences solutions at Liaison Technologies, told Healthcare Dive. The cloud can offer low-cost solutions to MACRA reporting and compliance, Palgon added.
He argued that practices with limited resources should look to cloud-based solutions in preparation for MACRA.
“Cloud-based solutions, in general, help to lower the bar to small organizations and those with limited IT capabilities.”
Vice president for healthcare and life sciences solutions, Liaison Technologies
Cloud computing use "removes companies from having to lease data center space, purchase, install and maintain software and offers the additional benefit of subscription-based pricing in most cases — all of which are very important to smaller practices because they typically don’t have any or much in the way of IT staff and the pricing model allows them to pay for operational expenses rather than capital expenses,” Palgon said.
Using a data-centric approach
Georgia Health Connect (GaHC), a health information exchange (HIE), is focused on helping small practices in the state of Georgia. Developed by the Georgia Health Information Technology Extension Center, the HIE features a patient data repository and community patient record, integration with Georgia Health Information Network, practice and hospital onboarding, a performance quality dashboard, electronic lab and radiology orders and results as well as direct-messaging. A top-shelf package also includes features like medication reconciliation and an eHealth exchange service.
GaHC offers the capability to integrate practices electronically between their electronic health record systems and the multistate-linked Ga-HIN, explained Palgon, whose firm is providing the cloud technology for GaHC.As patient encounters occur, the information is automatically relayed to GaHC and then registered with GaHIN so that any provider within the multistate area with rights to view the patients’ information can access it. This data-centric approach not only allows practices to comply with MACRA requirements but also adds value to the patient information that clinicians get.
It also allows small practices to have some of the same systems that large practices and health systems are able to afford, according to Dr. Dominic Mack, executive director of GA-HITECH and GaHC. “With MACRA, most of it is about providing disease registries so the providers can look across their patient population and see how they are meeting these quality measures that are required by MACRA for this value-based program," Mack told Healthcare Dive. "But it also allows them to see how they’re doing in relation to other practices on the same HIE.”
Hyder argued practices need to grasp which reports and dashboards are available and what insights and knowledge can be gleaned from patient data to improve the population health. They also need to consider patient-focused technologies that support MACRA’s focus on engaging patients in their health.
“The key to improved patient outcomes is focusing on capturing the right data in real time that is accurate and relevant and using that data to create knowledge to drive action,” Hyder said. “Whether you partner with experts in the field or go it alone, you need to evaluate your population health, EMR and data strategies.”