Black Book’s Top 10 MACRA Trends for Physicians

June 2017

As the healthcare industry prepares for the imminent ramp-up of MACRA’s (Medicare Access and CHIP Reauthorization Act) rollout, physicians and clinicians are grappling with the necessary steps in a variety of areas. Black Book recently concluded a survey of nearly 9,000 practices to assess how they’re managing the transition and has released the top 10 most pressing issues and trends among respondents.

1. A Gap in the MIPS Technology Market
While physicians are eager to finalize their efforts to transition into MACRA compliance, they’re struggling to figure out how to convert existing technology to meet the task. Seventy-seven percent of surveyed doctors indicated that they are actively seeking vendors who can provide comprehensive systems for managing Merit-Based Incentive Payment Systems (MIPS) and Advanced Alternative Payment Models (APM) processes.

More than 90 percent of surveyed clinicians said they don’t know of any vendors providing solutions for all MIPS requirements and so don’t yet know how they’ll manage the completion of 2017 reporting.

2. MACRA Spurs an EHR Revamp
In 2018, physicians will be required to use electronic health records (EHR) systems that meet 2015 certification standards. Now, the additional requirement to convert to systems that are also capable of handling MIPS processes has driven many practices to abandon old providers whose platforms don’t have the necessary agility.

As a result, the market is expected to move en masse towards the top eight EHR providers. Seventy-two percent of surveyed practices have been using solutions from smaller providers, many of whom have no plans to update their systems and are not required by MACRA’s provisions to do so.

3. MACRA Consultants Enjoy a Market Boom
Surveyed practices agree nearly unanimously on the importance of initiating expert-driven technology inventories in the course of transitioning to MACRA-compliant systems, spurring a boom in the MACRA consultant market. However, nearly as many practices say they don’t have the resources to hire those consultants and don’t expect to be able to in 2017.

4. Uncertainty Reigns for Small Practices
On its face, MACRA compliance should be relatively straightforward for 2017, as practices only need to exhibit performance improvement activities in a single area to meet the standards. However, even that relatively low bar seems difficult for many small healthcare providers, with 81 percent of those physicians saying they’re not sure how or whether they’ll be able to meet the goal.

5. Physicians Confront the Ticking Clock
Experts say that completing relevant transitions by the end of 2017 is vital, as MACRA’s provisions are set to accelerate in 2018. However, 80 percent of healthcare providers say they don’t yet have a strategy to complete the MACRA transition. Worse, 91 percent of practices that haven’t begun a technology change say they don’t think they’ll be able to find qualified IT staff to run the systems even once they’re installed.

Still, 22 percent of surveyed physicians are confident they’ll meet the standards under a delayed program implementation.

6. Independent Physicians Prepare to Sell
Anxieties about MACRA implementation are highest among independent physician practices, with more than 75 percent of those providers saying they’re strongly considering selling the practice and becoming employees of a larger organization in a bid to avoid the administrative costs of transitioning. Nearly 70 percent of those providers say they view the MACRA transition as a direct threat to the survival of their independent practice.

The outlook for physicians already affiliated with a hospital or larger organization is much more optimistic, and 77 percent of those respondents say they primarily view MACRA and MIPS as an opportunity to increase revenue activity and improve the course of patient care.

7. Hospital Practices Lean on Incentives
MIPS standards, beginning in 2019, will lead to drastic funds redistribution from under-performing providers to those meeting the requirements, with nearly $200 million at stake in the first year alone.

As a result, physicians aligned with hospital organizations plan to rely heavily on incentives to ensure the transition is complete in time, with 64 percent of hospital-linked providers expecting some form of incentive activity. Nearly 90 percent of those hospitals say they have plans to include performance activity and ratings in the criteria they’ll use to determine compensation for individual physicians.

8. Public Performance Reporting Flies Under the Radar
The Centers for Medicare and Medicaid Services (CMS) plan to publish provider performance data on their publicly accessible Physician Compare website, but 54 percent of all survey respondents said they hadn’t known this fact beforehand. Such data will also be made available to private providers of review and comparative websites, including Yelp, Angie’s List, and Google.

Nearly 95 percent of respondents were unsure how to predict what their 2017 MIPS scoring might be, and only 22 percent said they were aware that providers have the opportunity to choose metrics for public reporting that they feel best represent the strengths of their practices.

9. Small and Rural Providers Push for ACO Inclusion
To meet the infrastructure requirements that impact MIPS scoring, 67 percent of small practices say they plan to join an Accountable Care Organization (ACO), allowing them to shift the calculation of resource utilization metrics in their favor. An additional 82 percent of rural providers also plan to join an ACO to mitigate cost structure penalties.

10. Providers Assess Public Visibility
Consumer respondents consistently indicate that they are highly aware that reviews and ratings for physicians and hospitals are easily accessible online, and 12 percent of healthcare patients say they’ve visited such a site within the last year.

As a result, 52 percent of the largest providers and organizations say they’re already planning how to include administrative reporting costs in tandem with quality metrics for their clinicians.

A Gap in Expectations
While respondents from large organizations adopted a mostly optimistic outlook, Black Book’s survey revealed that smaller providers are much less sure about their place in MACRA’s landscape. Whether lacking resources or personnel, it’s clear that individual physicians and small practices will require a hard push and significant support to meet the looming deadlines.

To discuss the financial health of your medical practice, or to request more information regarding MACRA, contact Goldin Peiser & Peiser.

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