4 pillars for practices to succeed under MACRA


The uncertainty of the healthcare landscape created by the election of Donald Trump and his new administration only accelerates the need for the country’s healthcare organizations to deliver better quality medicine, says Robert Pearl, M.D., president and CEO of The Permanente Medical Group.

Fortunately, the challenge is more about economics and mathematics than it is about politics, Pearl said in an interview with FiercePracticeManagement at the recent AMGA 2016 “Succeeding Under MACRA” conference in San Francisco.

MACRA, the new Medicare physician payment system, is designed to push healthcare to a value-based system that uses technology, provides better quality, and costs less, he said.

MACRA will compensate physicians based on quality-based metrics and patient outcomes under two pathways: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (AAPM).

Medical practices that will be most successful under MACRA will need to embrace APMs, said Pearl, who is also chairman of the Council of Accountable Physician Practices, a coalition of America’s high-performing multi-specialty medical groups.

“If you look at MACRA…MIPs is not the destination. It may be a first step. But ultimately, you’ve got to become an alternative payment model,” Pearl told audience, because those practices will receive the highest reimbursement under the new payment system.

Healthcare organizations that are successful in moving forward in the pay-for-value world, have built on the following four pillars, which medical practices must adopt, he said in the interview:

Integrate your care. Integration is key, he said. For instance, have the right number of physicians and specialists so you can offer patients more rapid, convenient care.

Move to a pre-payment system. Medicine is moving from fee-for-service to paying for value. Such a system creates incentives and will reward physicians for preventing disease and avoiding medical complications, he said.

Use technology to support your practice. There are three keys: using video or telemedicine; using predictive data analytics to tell you, for example, if a patient is at risk for getting sicker so you can intervene before that happens; and expanded use of electronic health record systems so they are used as a communication tool.

Promote physician leadership and development. Permanente uses mentoring and training programs to help create physician leaders, he said. Doctors are going to be willing to follow the leadership of their colleagues in a changing healthcare environment.

“My basic message is that this is a time for physicians across the United States to lead,” he said. “I think patients trust physicians to do the right thing for them.”

Watch the session in full on Periscope: