MACRA for Busy Docs: 12 Things to Know

Leigh Page


September 07, 2016

In This Article

Not All Physicians Will Play a Part

12. Employed Physicians Aren't Directly Affected

As bonuses and penalties rise under MIPS, one might expect that hospitals would be passing them on to their employed physicians, but this is not the case.

Instead, hospitals have been using their own metrics to measure the quality of care of their employed physicians and often adjust their salaries accordingly, says Maria Hayduk, an associate principal at ECG Management Consultants in St Louis.

Hayduk points to a 2015 ECG survey that hasn't been released to the public. The survey found that 57% of healthcare organizations now link quality metrics to an extra payment, up from 27% in 2011. In 2015, this extra payment amounted to 6.3% of base pay for PCPs and 6.5% for specialists, and PQRS and MU were the most common metrics used.

Dr Hamory predicts that this trend will continue. "Most hospitals and group practices provide payments for meeting quality metrics," he says. "These are often quality metrics similar to current PQRS measures—and they will probably mirror the MIPS measures in the future."

Although there is much to learn about MACRA, there's also one important thing to keep in mind: MACRA could end up different in the final rule. CMS released almost 1000 pages of proposed regulations[8] for MACRA in April, and the final rule is expected in late October.

The agency asked many questions of stakeholders in the proposed rule about such areas as the use of medical homes, changes in MU, and financial risk for small groups. This suggests that the final rule could be quite different from the proposal.

"I don't get too excited about proposed rules until I see the final version," says Bobbi Brown, vice president of financial engagement at Health Catalyst, a Salt Lake City-based company that helps practices improve their operational outcomes.

To do well in the MIPS Quality category, Brown suggests tracking more measures than you'll need to report. "If you want to report the measures you're doing well in, you need to understand which ones they are," she says. "So you might collect data on as many as 15 quality measures, and then at the end of year, pick the six you do best with."

Reports on 2017 measures are not due until March 31, 2018. "It's still possible to go back to the data and choose new measures," Brown says, "but it takes a lot more effort to do this than to collect it in real time."

Patrick advises physicians to start planning now, before the final rules are issued. If you're already in PQRS, this means reviewing your PQRS performance data. "Consider what performance category you need to work on to improve it, so you can have a chance to improve performance during the year," she says.


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