Ideas to make MACRA more applicable to more clinicians

CMS

Reduced reporting burden and greater flexibility for smaller practices would make the Medicare Access and CHIP Reauthorization Act (MACRA) a more workable proposition for more practicing clinicians, according to three policy leaders.

MACRA’s current incarnation will likely lead to further consolidation of providers, which does not correlate with improved healthcare outcomes, write Mark McClellan, M.D., Frank McStay and Robert Saunders, M.D., in their post on the Health Affairs Blog

Much of the concern regarding the current iteration of the Centers for Medicare & Medicaid Services' (CMS) proposed MACRA rules revolves around the difficulties the legislation presents for small and independent practices, which has led to widespread concern among advocacy organizations and increased potential for CMS to delay the rule’s implementation, per previous reporting by FiercePracticeManagement.

The three leaders, all from the Duke-Margolis Center for Health Policy, offer suggestions for better accommodating clinicians’ needs:

  • While alternative payment models (APM) offer the most reward for taking innovative risks, the huge effort required to research and develop new payment models tends to mitigate against their development, especially among smaller practices. The authors suggest “an expansion of the ‘preferred provider mechanism’ from the Next Generation ACO model,” in order to reward providers who work with larger organizations involved in APMs.
  • The Merit-Based Incentive Payment System (MIPS), meanwhile, will require new administrative and reporting practices. CMS has worked to increase reporting flexibility for providers, but the authors write that ease of reporting doesn’t necessarily make the metrics meaningful in terms of improving care, especially if self-selection makes it possible for too many clinicians to effectively game the system in order to max out their reward payments. They suggest CMS focus on identifying better metrics first, and then look to mandate consistent reporting. 
  • The authors also take issue with the proposed speed and format of feedback from CMS, which they say would be better if it came more frequently and in a form that allowed clinicians to take action quickly enough to “improve care within the time frame for which they are being evaluated.”