8 Key Facts About MACRA

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October 25, 2016

In This Article

Reporting Requirements Have Many Elements

2. You'll Still Have a Lot of Reporting

There are two tracks in MACRA: advanced APMs and MIPS, which prepares clinicians to join advanced APMs. But the Centers for Medicare & Medicaid Services (CMS) estimates that only 4%-11% of clinicians will initially qualify for advanced APMs, according to a report[1] by the Brookings Institution. So the vast majority of eligible clinicians will be in MIPS.

Andy Slavitt, acting administrator at CMS, says reporting will be significantly cut under MIPS. CMS will be "reducing by one-third the number of quality metrics that need to be reported and we have aligned the measures across categories to end repetitive reporting," Slavitt told[2] the American Osteopathic Association in July.

There will, however, still be a great deal of reporting left. CMS estimated in the proposed rule that it would take roughly 7-18 hours, depending on the complexity of the submission, for a practice to submit quality data for one clinician.

The total reporting burden for quality measures, such as the Physician Quality Reporting System (PQRS), is even higher, according to a recent study[3] in Health Affairs. Primary care, cardiology, orthopedics, and multispecialty practices spent an average of 19.1 hours per physician per week on quality measurement, and physicians themselves spent almost 4 hours per week on this work.

Lauren Patrick, CEO of Healthmonix, a company based in Malvern, Pennsylvania, that helps practices report quality information to CMS, says that claims of less reporting need a little editing. True, she says, MIPS clinicians will have fewer items to report in both the electronic medical record track and the quality track. For example, there are only six MIPS quality measures, compared with nine measures under PQRS. However, the quality measures will have to be reported much more thoroughly under MIPS.

Whereas clinicians have to report measures on 50% of all their Medicare patients in PQRS, Patrick says under MIPS they'll have to report on 80% of all patients, not just Medicare patients. Also, she says, clinicians will no longer be able to report on just 20 patients for some measures, which has been possible under PQRS.

In contrast, the new Clinical Practice Improvement Activities (CPIA) category will be very easy to report, says Greg Fulton, industry and public policy lead at Philips Wellcentive, a value-based care company in Alpharetta, Georgia. However, he concedes that actually carrying out a new practice improvement activity, such as implementing same-day appointments, would be time-consuming.

3. Clinicians Can Report in Groups

Contrary to what you might have heard, clinicians can reduce their MIPS reporting burden by reporting together in a single submission, according to Tom S. Lee, PhD, founder and CEO of SA Ignite, a Chicago-based company that helps organizations manage value-based programs.

"It would be administratively simple to report as a group," he says. However, whereas large groups are likely to have the staff and IT capabilities to centralize reporting, smaller groups may not have these resources. Thus, the MACRA law would allow small practices to band together in "virtual groups" that could centralize resources.

The proposed rule would allow practices with 10 or fewer clinicians to join these virtual groups, but it delays implementation until after the first year. The delay seems to be due to the problems that CMS might have with receiving information from clinicians who have different Medicare identification numbers.

There may also be problems for participants, says Maria Calamaro, product director at Healthcare Administrative Partners, a billing and coding company in Media, Pennsylvania. "Virtual groups are a very interesting concept, but the devil is in the details," she says. "It would be hard to aggregate data if members of the group use different electronic health record (EHR) systems and other technology."

Moreover, group reporting in general has some disadvantages, according to Lee. In a group, "you would have limited ability to choose specific measures," he says. In following the measures the group chooses, "you may be forced to accept measures for activities where you don't perform that well."

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