MANAGED CARE Q&A

Provider Groups Express Concerns With MACRA Transition

September 26, 2017
Authors: 

David Costill

An Interview with Jacqueline W Fincher, MD, MACP, Chairman of the Medical Practice & Quality Committee at the American College of Physicians (ACP).

In your experience, are providers ready for the transition to MACRA?

It truly depends on where you are, and what type of practice setting you are in.

Physicians and other providers who are part of large health systems or academic centers are really depending on the Chief Medical Officers, Chief Information Officers, and Quality Improvement Professionals to provide them with the information and workflows needed for implementation, along with putting the requirements, regulations, and data submissions into place for them. Private practices have much more skin in the game.  These physicians and providers generally know much more about the Quality Payment Program (QPP), but are concerned they don’t know enough to be successful in the transition. Most of these providers have already been participating in the Medicare Physician Quality Reporting System (PQRS) for several years, along with the Meaningful Use (MU) program. In addition, they have automatically been part of the Value Added Modifier program. So, in a sense they have already been doing what they will be asked to do for QPP. It will all just be combined into one program with a new scoring method. It is the scoring method and how that extrapolates into payment that is the most worrisome to providers. Physicians want to understand the scoring method so they know where to concentrate their energies, change their workflows, and have a pretty good idea of how they are doing long before they have submit data for an official score which will translate into their payment.

ACP recommendations are aimed at simplifying the QPP, can you discuss some concrete ways the QPP can be improved and simplified?

1. The scoring method that CMS has proposed is ridiculously complicated, making it very difficult for practices to keep their own running scorecard. There are four weighted performance categories areas that make up the composite performance score, and it is an equation that will change over time.  To start with in 2019 the equation is:

Quality 60% + Advancing Clinical Information 25%+ Clinical Improvement Activities 15% + Cost 0% = MIPS Composite Performance Score.

The problem is within each category CMS has a very complicated methodology for the weight of points that does not fully align with the value of the category.  It is this complexity that makes it very difficult for physicians to understand and follow their own performance score internally in real time. Practices cannot afford to wait 2 years and a potential pay cut to know how they are doing. ACP has proposed a much simpler scoring system, where the percentages of the total score actually are the points in each category. The available points within each category would actually add up to the percent of each category, for example, in the quality category there would by a total of 60 available points, and thereby counting for 60% of the score. 

2. ACP has strongly recommended that the Quality performance category, along with the ACI and Clinical Improvement Activities be set at a 90-day reporting period, so that physicians can gradually prepare for full participation and learn from each reporting period and thereby gain competence and confidence in the new system.

3. ACP has strongly recommended that CMS prioritize moving the performance period MUCH closer to the payment adjustment year as soon as possible. It will give physicians much more timely feedback and facilitate meaningful improvement.

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