Ingrid Hein

April 03, 2017

A free online tool to help physicians understand and embrace the Medicare Access and CHIP Reauthorization Act (MACRA) was launched by the American College of Physicians (ACP) at their Internal Medicine 2017 meeting in San Diego.

"The ACP and other societies are trying to get the word out to physicians so they are aware that this system is much better than what we had before," said Shari Erickson, MPH, vice president of governmental and medical practice at the ACP.

"This is a major change in policy and there is quite a bit of trepidation," she told Medscape Medical News, not because the change isn't the right way to go, but because the process of change is difficult.

Physicians are distrustful of changes made by the Centers for Medicare and Medicaid Services (CMS), and are finding the new 2200-page quality reporting law to be daunting, she explained. "They don't realize the new system is actually easier for quality reporting."

What's more, information about MACRA has not been disseminated in a format that is easy to absorb or embrace. "Any change in a policy and a program can be difficult to understand," said Erickson. "CMS is a payer and a regulator, not a marketing institute."

They don't realize the new system is actually easier for quality reporting.

The Quality Payment Advisor tool is designed to help users navigate the overwhelming amount of information that comes with MACRA and to help organizations get started in the program. A complex algorithm, developed in collaboration with two external technology teams, provides the information and resources that are most appropriate for an individual practice.

"It asks what you know and what you don't know — what we call a 'practice biopsy' — so you can get to a place where you can learn the steps to be successful, and helps identify the most reasonable pathway for you," Erickson reported.

It can also help determine the pace at which a practice should wade into the MACRA Quality Payment Program in 2017, and whether to use the Merit-Based Incentive Payment System (MIPS) or the advanced Alternative Payment Model (APM).

The content, rules, and structure of the tool were developed by ACP staff on the basis of another tool already in use, called the Practice Advisor. "It takes about 10 minutes to get through the algorithm. Then you can access additional information for specific needs," said Erickson.

Do the Minimum to Avoid Penalties

The new laws allow physicians to create their own conversion rate, based on their score, Robert McLean, MD, chair of the ACP medical practice and quality committee, said during a news conference. Physicians need to understand the history — that MACRA replaces the Medicare sustainable growth rate formula, which was implemented to control healthcare spending. "In a crazy way, this gives physicians more control over their fee schedule" because they can choose to implement more or fewer measures, he pointed out.

Ultimately, the ACP wants its members and other physicians to understand the benefits of the new system, what they need to do to get started, and how to avoid penalties.

The 2017 reporting requirements are "not overly onerous," Erickson explained, and you can "pick your pace." For this first year, the program has been simplified, so only one quality measure needs to be reported to prevent a 4% negative payment adjustment down the road. "We want our members to learn about this first step," she said.

"If a practice is ready, it can take the next step and file 90 days of quality," she added. This second level of participation not only helps the practice avoid negative adjustment, it also provides the opportunity for a positive adjustment.

The bottom line is, "do the minimum for 2017," she said. The intent is to get people to test it out. "We're trying to get the word out to all the clinicians across the country."

Change can be difficult, she acknowledged. The system will continually change, and physicians know that once they start reporting, they will have to keep up.

"It's messy and it's frustrating," she said, which explains "why physicians are not coming on board." To make the process less intimidating, "we're talking about it to our members and meeting them where they are, acknowledging that their concerns are valid."

American College of Physicians Internal Medicine (IM) 2017. Presented March 31, 2017.


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