MACRA Flexibility Creates Complexity


November 14, 2016

Jump Start MACRA Success By Completing A Strategic Assessment

The final rule of the Medicare Access and CHIP Reauthorization Act (MACRA) contains several flexible options created by public comment and demand. 

The American Medical Association president, Andrew Gurman, MD stated “By adopting this thoughtful and flexible approach, the administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country."

This flexibility creates options that result in complexity for providers as they prepare to transition to one of two value-based payment models: 

·     Merit-Based Incentive Payment System (MIPS) 

·     Alternative Payment Models (APMs)

To navigate this complexity, we recommend providers complete a MACRA Assessment to prepare for the transition. Your assessment should include comprehensive review of technology, analytic, financial, and operational systems. Remember, MACRA is a change in the business model with quality, financial, and technical implications.

In fact, the complexity requires development of a comprehensive strategy before effort begins. This transition doesn’t lend itself to the decide-as-we-go approach so often applied in technological change initiatives. There are simply too many operational and financial risks to begin without a clear strategy. Executive teams should determine what they will and won't tackle as part of the MACRA transition. There are choices to be made - remember the final rule's flexibility. Start by considering the following approaches:

  1. Plunge into managing MIPS on your own. This will require significant resource utilization to develop analytic & technical capabilities. This will be difficult for independent physicians.
  2. Decide Not to Participate - prepare for a 9% pay cut. Alternately, solo or independent physicians could stop seeing Medicare patients rather than take the cut. This would result in worsening physician shortages.
  3. Join APM: physicians can join (or develop) a network to participate in an Alternative Payment Models, such as Comprehensive Primary Care Plus (CPC+) or a Next Generation accountable care organization (ACO). 
  4. Stay in APM: leverage the experience of ACO by participating in a Next Generation ACO Model that focuses on achievable financial targets, opportunities to coordinate care, and holds the attainment of high quality care as the objective.
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