Top 10 MACRA trends challenging providers

The need for new or upgraded software, provider consolidation and hiring consultants are some of top trends practices will need to contend with as they prepare for the new payment tracks in the Medicare Access and CHIP Reauthorization Act (MACRA).

Black Book Research based its top 10 list on a crowd-sourced survey from 8,845 physicians practices conducted between February and April 2017.

1. Booming market for technology to comply with Merit-based Incentive Payment System (MIPS)

Of those surveyed, 77 percent of practices with 3 or more clinicians are looking to buy MIPS compliance technology by the fourth quarter of 2017.

Quality measurement, however, was not the main reason for shopping for MIPS compliance tech. 89 percent said it was because “they can’t decipher their MACRA earning potential.”

2. Many are upgrading EHRs to handle MIPS

MIPS compliance upgrades are being performed by 83 percent of those using the eight largest EHR systems (Cerner, Epic, Allscripts, eClinicalWorks, NextGen, athenahealth, Practice Fusion and GE Healthcare).

The customers of EHR vendors outside the top eight, however, are acting differently. 72 percent of those users “they were not working with their vendor to ensure they were prepared for MIPS measures and can properly report the data.”

3. Demand is high for MACRA consultants

“MACRA consultants are busy identifying and developing tools to support innovative projects as well as to bring clinicians on board as quickly as possible but hard to contract currently because of demand,” said Black Book managing partner Doug Brown.

For smaller practices of three or fewer physicians, 75 percent said managing the technology will be a challenge, but said they can’t afford to hire a consultant.

4. Aligning data with MACRA measures confuses physicians

81 percent of independent physicians in practices with four or more clinicians reported having trouble grasping “how to align data with the reporting measures.”

“Seemingly, the MACRA requirements appear fairly easy to meet, you simply attest to at least one performance improvement activity. However, the reality will be significantly more difficult as smaller practices in particular begin preparing for risk,” Brown said.

5. Many practices are counting on last-minute outsourcing

With 2017 being a “pick your pace” year for MIPS participation, practices are putting off developing a MACRA strategy. 22 percent said they’re depending on the payment tracks being delayed.

Of those which haven’t settled on a MACRA plan, 80 percent expect to “select a turnkey software or outsourcer” to catch up later in 2017.

6. More independent physicians could sell their practices

Though the aim of MACRA is to reduce the reporting burden on clinicians, 68 percent said they see the new payment tracks as a “burden or bust” to staying in independent practice through 2020.

7. MIPS performance incentives will be available

For eligible MIPS clinicians, up to ten percent above the maximum positive payment adjustment can be earned in the first five years of MACRA. To take advantage of this, 64 percent of hospital-networked physician organizations said they’ll incorporate MIPS performance incentives in provider compensation models. 88 percent of hospitals surveyed have been seeking ways to “ensure individual performance scores are reflected in the compensation” of employed physicians.

8. Reputations are on the line

54 percent of survey respondents said they were unaware CMS will publish MIPS data on its Physician Compare website. Despite this, 94 percent said they were unaware or unsure of how to predict their MIPS scores in 2017.

9. ACOs are looking more attractive to small, rural providers

67 percent of smaller practices said they’re considering joining an accountable care organization (ACO) to avoid lower scores caused by a lack of infrastructure and resources. It’s even more popular among rural providers, with 82 percent saying they’re considering joining an ACO.

10. Providers are taking notice of publicly available data

52 percent of large group practices, including ACOs, say they’ll be starting to address in 2018 how costs will be reported for every clinician, “along with results of quality measures,” as a reaction to more consumers becoming aware of online physician ratings.