Many Doctors Still Not Ready for Key MACRA Program: Survey

Ken Terry

June 28, 2017

Halfway through the first year of the Quality Payment Program (QPP) of the Centers for Medicare & Medicaid Services (CMS), a majority of physician practice leaders are still not very familiar with the program, according to a new survey of 1000 physicians who had heard of the Medicare Access and CHIP Reauthorization Act (MACRA) and are involved in practice decision-making related to QPP.

Yet 90% of the respondents whose practices plan to participate in the QPP's Merit-Based Incentive Payment System (MIPS) believe its requirements are slightly burdensome (37%) or very burdensome (53%), according to the poll, which was fielded by KPMG and the American Medical Association (AMA).

A slight majority of respondents (51%) were somewhat knowledgeable about MACRA or QPP, but only 8% of the physicians said they felt deeply knowledgeable about QPP and its requirements. While the latter percentage ranged from 6% of soloists to 11% of doctors in practices of 50 or more providers, the level of knowledge was roughly similar across different practice sizes.

However, physicians in small practices were more likely to view QPP reporting requirements as very burdensome than doctors in large practices. They were also more likely to say they were not at all prepared for financial success under QPP.

Fifty-six percent of respondents expected to participate in MIPS in 2017. Just under 2 in 10 doctors expected their organization to meet the definition of a qualifying alternative practice model (APM) participant, which would exempt them from MIPS reporting. Another 7% of respondents expected to participate in an APM that didn't meet that standard. Eight percent of respondents did not expect to participate in MIPS, and 12% said they hadn't decided whether or not to participate.

Of those not planning to participate in MIPS, nearly half had voluntarily chosen not to do so; the other half expected to be exempted as a result of the low-volume threshold for Medicare revenue or patients. (The survey was conducted before late April, when CMS notified physicians and practices about whether they cleared the threshold for MIPS participation.)

Of the physicians who planned to participate in MIPS, 3 in 10 intended to report the minimum amount of data possible, which is one quality measure or one practice improvement measure in 2017. A quarter of those doctors planned to report partially (more than one measure), and 3 in 10 said their practices had chosen full MIPS reporting. Two percent of respondents expected to report as a nonqualifying APM in 2017, and 12% didn't know what their practice was doing.

Three quarters of physicians who planned to do the minimum this year said they'd report on a quality measure. Nearly three quarters of MIPS-participating physicians said they planned to report as a group, rather than as an individual. Three fifths of MIPS participants planned to use their electronic health record (EHR), qualified registry, or qualified clinical data registry to report performance in 2017. The rest will presumably file a special type of claims, as they did in the Physician Quality Reporting System.

A Helping Hand>

The survey showed that a third of respondents are unlikely to satisfy the single-measure requirement this year to avoid a financial penalty in 2019, said AMA President David Barbe, MD, in a news release. "To help physicians meet that standard, the AMA developed and deployed resources to guide physicians toward compliance," he noted. "Our resources include a step-by-step video on minimum reporting requirements to avoid a penalty in 2019 and a payment model evaluator that offers a brief assessment of where a practice stands."

Seven in 10 respondents had begun preparing to meet the requirements of QPP in 2017. Of those physicians, 65% said they were somewhat prepared and 23% said they were well prepared to meet QPP requirements this year. Seventeen percent of respondents had not begun preparations, and 13% were not sure where they stood. Of those who had not begun preparing, a third planned to do so by July, and nearly half expected to do it by November.

Respondents saw several challenges in complying with QPP requirements. Two thirds of the physicians expressed concerns about the amount of time required to report. More than half of respondents said they needed help with understanding the reporting requirements (58%) or the MIPS scoring process (57%). Fifty-three percent were worried about the cost required to accurately capture and report performance (53%).

Underscoring uncertainty about QPP, 34% of respondents said they weren't sure whether their practice planned to participate in MIPS in 2018. Fifty-six percent expected they'd report MIPS data next year, and 10% did not anticipate reporting.

Of those physicians who plan to participate in MIPS in 2018, the survey found, 65% believed they would be prepared to meet program requirements next year.

Among respondents not currently participating in an APM with a private payer, nearly half believed that more APM options are needed for them to qualify for the advanced APM program in 2018.

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