November 28, 2017
A recent research letter in JAMA Oncology found that to less than one-third of oncologists partially or fully participate in MACRA in 2017.
“In addition to addressing the issue of the uninsured, the Affordable Care Act launched government programs to bend the health care cost curve by incentivizing clinicians to deliver high-quality care in a cost-effective manner,” Chadi Nabhan, MD, MBA, Chief Medical Officer at Cardinal Health Specialty Solutions, and colleagues wrote. “Since most cancer diagnoses and deaths occur among Medicare patients, the impact of the quality payment program (QPP) on oncology care will be substantial. Successful implementation of the MACRA QPP requires a long-term strategic vision and a paradigm shift in US cancer care delivery models.”
The researchers emphasized that MACRA participation among oncologists is particularly important to patient outcomes and care value.
“Oncologists have expressed legitimate concerns about meeting the MACRA QPP requirements while preserving the financial viability of their practices,” they wrote. “Over 80% of cancer patients are treated in the community, underscoring the need to study barriers to successful implementation so that patient outcomes are optimized.”
The researchers conducted live, large group interviews with 355 oncologists, hematologists, and practice administrators, between November 2016 and June 2017. They asked questions related to three aspects of the QPP, including program knowledge, implementation challenges, and overall impact. They surveyed clinicians using multiple-choice, audience response technology that allowed them to choose more than one answer per question. A total of 31% of study participants were from oncology care model (OCM) participating practices.
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“We believe that the perceptions of oncologists about the MACRA QPP can provide valuable insights for all stakeholders in this historic transformation from volume-based to value-based health care,” Dr Nabhan and colleagues wrote.
Study results showed that only 4% of participants that responded stated they had an in-depth understanding of the MACRA QPP. Among the remaining respondents, 43% indicated they were somewhat familiar with MACRA, 9% stated they had never heard of it, and 44% stated they recognized the name but weren’t sure about the details.
Among 192 non-OCM participating practices, only 14% responded that they planned to fully participate in MACRA in 2017, and 15% reported plans to partially participate.
The researchers also assessed the oncologists’ level of confidence regarding the transition to MACRA. They found that 75% of respondents indicated that they had no readiness in regards to assuming the financial risks of hospitalizations and emergency department costs under MACRA.
“Barriers to successful MACRA QPP implementation were mainly lack of knowledge and resources,” Dr Nabhan and colleagues concluded. “We highlight critical gaps that need urgent interventions by all stakeholders to ensure success of the program in oncology, guarantee quality care, and mitigate chances of failure. While ongoing efforts by policy makers are commendable, our findings highlight a persistent gap that requires efforts to assure sustainability.”
The researchers also highlighted strategies to tackle the educational needs of oncologists, including: practice-level financial counseling, frequent assessment of measured milestones, monitoring of patient outcomes, and impact on overall cost of care.
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