MACRA: Reporting for Quality’s Sake


Post by Brad Miller


Vice-President of Clinical Solutions, Caradigm

Now that we’ve had some time to think about the Medicare Access and CHIP Reauthorization Act (MACRA) and digest the details, a few high-level points stick out. First, it does away with Medicare’s Sustainable Growth Rate (SGR), which few physicians were in favor of due to the detrimental impact on services fees. Second, it consolidates and simplifies current reporting programs that were viewed by some as reporting for reporting’s sake– Physician Quality Reporting System (PQRS), Value-based Purchasing (VBP) and Meaningful Use (MU). For example, in the Merit-Based Incentive Payment System (MIPS) track of MACRA, providers only have to report on six measures, instead of the nine required in PQRS, and they also have greater flexibility in choosing what those six measures are. Third, and most importantly, CMS’ ultimate goal with MACRA is to move healthcare further to a system based on quality, and to accelerate the shift in how providers use technology to improve patient care and outcomes. CMS believes that based on its conversations with thousands of clinicians and patients, most providers have yet to acquire the right set of technology tools to make care and reporting more effective and coordinated.

Andy Slavitt, Acting Administrator for the CMS describes one the main drivers of MACRA:

“With many hours of observations, what became clear was that the combination of technology, regulation and measurement took time away from patients and provided nothing or little back in return. Among other things, physicians are baffled by what feels like the ‘physician data paradox.’ They are overloaded on data entry and yet rampantly under-informed. And physicians don’t understand why their computer at work doesn’t allow them to track what happens when they refer a patient to a specialist when their computer at home connects them everywhere.”[1]

So, how should providers start preparing for MACRA? The first thing they need to determine is whether they will qualify for the MIPS or Alternative Payment Model (APM) track. It can be a complicated determination because some organizations could be considering entering into programs (e.g. NextGen ACO) that would impact which track they will qualify for in the future. Next, they should assess their current ability to succeed in all of their value-based programs, including how they will meet the MIPS or APM reporting requirements in order to qualify for bonus payments. Although it feels like the proposed rule was just announced, providers should begin strategizing for MACRA now because the performance period scoring for MACRA begins in 2017.

At Caradigm, we are already working to stay ahead of MACRA. This includes evaluating and prioritizing the proposed measures in advance of the final rule. We are also collaborating with customers to understand their specific requirements and to determine if there are any synergies with their other initiatives and applications. Our overall approach is to build a data aggregation and analytic foundation that can be used to support multiple initiatives and reporting requirements. That foundation has to be robust yet nimble and efficient so organizations can scale programs and evolve rapidly to meet future iterations of requirements. We have architected our technical solutions to help technology support, rather than be a burden, on the progress of providers.

MACRA is a broad topic with lots of areas to explore and many implications for providers, so we will be discussing different parts of it regularly on this blog. If you’re interested in speaking about your quality reporting and MACRA needs further, then please send us a note here.

[1] Slavitt, Andy. “Datapalooza: MACRA, HER Reform and Working with Doctors – Not Against Them.” The Health Care Blog. May 12, 2016. Originally published: http://thehealthcareblog.com/blog/2016/05/12/datapalooza-macra-reforming-meaningful-use-and-working-with-doctors-not-against-them/