MACRA Solutions

Our New MACRA Solution Helps You Stay Ahead

MACRA (Medicare Access and CHIP Reauthorization Act) continues as the rule on Medicare physician reimbursement that reforms the payment model through a quality-based program that includes penalties and bonuses tied to performance. While some organizations delayed planning to see if MACRA would continue under the Trump Administration; the 2018 rule released was largely the same.

Why MACRA Is Necessary for Healthcare

MACRA stabilizes the reimbursement landscape and improves patient access to physician information, but it places tremendous reporting demands on health systems and clinicians. The final rule for 2018 offers more chances to succeed and has given additional flexibility.

Why MACRA Is Challenging for Health Systems

Originally comprising more than 2,400 pages of regulations, the 2018 rule adds an addition 1,563 pages, which means clinicians need to interpret numerous reports and understand the implications of these regulations on their organizations. MACRA places tremendous reporting demands on health systems and clinicians. Clinicians must also choose which measures they’ll go at risk for—an added strategic decision-making demand on top of the reporting demands. Now into the second performance year, the Quality performance category has increased the reporting period from 90 days to a full calendar year. Perhaps more notably, CMS will assess providers on Cost measures in 2018, which had previously been delayed until 2019. The cost measure will be weighted at 10% in 2018 and increasing to 30% for subsequent years. There are two cost measures, Medicare Spending per Beneficiary (MSPB) and Total per Capita Cost (TPCC). CMS will calculate the cost measures and provide performance feedback on MSPB and TPCC by July 2018. Both measures were used in the Physician Value-Based Modifier Program.

CMS is evaluating ten additional episode-based measures, but these will not be used in the 2018 performance period. More clinician input is needed to evaluate these measures.

Click here to see all measure definitions.

Stay Ahead of MACRA with Health Catalyst’s MACRA Solution

Health Catalyst® has heard many concerns about MACRA from the health systems and clinicians we support.  Fortunately, as an outcomes improvement company with deep industry experience, we can help health systems not only navigate MACRA, but also stay ahead of the industry’s frequently changing regulatory demands with our new solution, MACRA Measures & Insights—the industry’s best opportunity analysis tool for helping health systems decide what quality measures to go at risk on.

CMS wants to increase the participation in Alternative Payment Models (APMs). This year’s update included provisions to make it easier to participate in select APMs, also known as Advanced APMs.  The list of qualifying programs has been expanded. Health Catalyst can assist health systems in defining a pathway to these various models. Health Catalyst can read claims data and convert the data to analytical applications to help manage the resources of a population.

View Products Associated with MACRA View Product Data Sheet

The Top Four MACRA Challenges Health Systems Are Up Against

The term “MACRA” is enough to induce panic among some health systems for four key reasons:

#1: Regulatory pressures are significant—and only increasing

Per a 2016 Health Catalyst/Peer 60 survey, health systems’ top MACRA concern is compiling metrics for regulatory reporting. There are many regulatory pressures on health systems that come from multiple sources: regulatory agencies, Meaningful Use, increasing costs, the need to improve safety and quality, risk contracts, etc.

#2: Processing quality measures is a major source of physician dissatisfaction

The average physician spends 15.1 hours/week processing quality metrics (Weill Cornell Medical College and Medical Group Management Association), which translates to $40,069 per physician, per year. MACRA requirements are likely to have increased this workload.

#3: The penalties associated with regulatory noncompliance

Under the MIPS track of MACRA, payments start at +/- 4 percent in 2019 and incrementally increase to +/- 9 percent in 2023.

#4: The lack of coordination between different departments (financial, regulatory, quality)

Significant human resources and manual processes are needed to assemble regulatory measures, which are difficult to compile, interpret, maintain, and understand.

Are Health Systems Ready for MACRA?
Survey Reveals Top MACRA Concern and Varying Degrees of Readiness

The 2016 Health Catalyst/Peer60 survey of 187 healthcare professionals (including 37 CEOs and 94 other C-Suite executives from organizations ranging from some of the nation’s largest urban academic medical centers and integrated delivery networks to small, rural critical access facilities) revealed their top MACRA concern and varying degrees of readiness.

Health Systems’ Top Concern: Compiling MACRA Quality Measures

The heavy lifting required to track and compile MACRA measures for reporting to Medicare is top of mind for healthcare executives. When asked which MACRA-related activities “pose the greatest difficulties for healthcare organizations,” 74 out of the 187 respondents (40 percent) ranked “compiling metrics for regulatory reporting” as the biggest challenge. The next biggest headache identified by survey respondents—18 percent—was the problem of “adjusting to greater coordination between providers and patients.”

Ready or Not, Most Health Systems Expect to Participate in MACRA

Only 35 percent (65) of respondents to the Health Catalyst survey said “we have a strategy and are well on our way to being ready” for upcoming MACRA reporting, based on 2017 charges. Ready or not, most do expect to participate, with only 5 percent of those surveyed planning to opt out of participating in the program entirely.

Progress on MACRA strategies was, surprisingly, slightly higher among small-and medium-sized hospitals, despite their relative lack of resources compared to large hospitals and health systems. Respondents who said they have a MACRA strategy for their employed providers but haven’t made much progress implementing it included just 26 percent (31) of small- and medium-sized hospitals compared to 33 percent (22) of large hospitals and health systems.

On the other hand, the number of respondents who reported they would participate in MACRA but currently have no strategy included 33 percent (39) of small- and medium-sized hospitals and 24 percent (16) of large hospitals and health systems. The reasons for a lack of strategy were varied, with the most common reason being that the organization was trying to figure out if providers could profit by participating in MACRA. Others said the work was too cumbersome, or they either had too little information on MACRA or they were overwhelmed with too much information.

Increase Flexibility With 2018 Changes

The following is a list of some of the increased flexibility brought about by the 2018 rule changes:

  • Low-volume threshold was raised. Exempt from MIPS if bill less than $90,000 in Medicare Part B or treat fewer than 200 patients annually (from $30k/100pts).
  • More bonus opportunities: Small practices, defined as 15 or fewer physicians, can get bonus points by submitting data on one performance category. Bonus points also available for treating complex patients (defined by HCC) or high numbers of dual eligible patients (Medicare/Medicaid).
  • Hardship exceptions added for those impacted by “extreme and uncontrollable circumstances.” Created to help those affected by Hurricanes Harvey, Irma, and Maria, although could be extended to others.
  • Some 2017 flexibilities were also extended: such as continued use of 2014 Certified Electronic Health Record Technology (CEHRT) for ACI transition measures.

Most Health Systems Believe Physicians Will Benefit from MACRA

Despite their relatively slow movement on MACRA, few hospitals reported being worried that the regulations would cost them money. Two-thirds of the 73 small- and medium-sized hospital respondents that reported having a MACRA strategy expect their employed physicians will either receive a bonus or break even, whether or not they have made progress on their strategy. Only one small hospital respondent said providers expected to receive a penalty, while nine said they weren’t sure.

The numbers were similar for large hospitals and health systems. Of the 45 respondents from large hospitals and health systems who said they have a MACRA strategy, 36 percent (16) expected their affiliated physicians to earn a bonus while 31 percent (14) said they expected physicians to break even. Just one large hospital expected their physicians to receive a penalty, while seven weren’t sure whether they would benefit or not.

The Bottom Line: Health Systems Are Marching Ahead with MACRA

Many health systems have hit the pause button on MACRA due to a combination of factors, including its complexity, the newness of the final rule, and uncertainty about whether the new Administration will make further changes. But those marching ahead are finding that compliance is likely to benefit their organization. The bottom line is that systems can choose which measures to report from their 2018 data, even if they haven’t finalized their MACRA compliance plan, and it’s likely worth their time.

The Solution to MACRA’s Challenges: MACRA Measures & Insights

MACRA Measures & Insights is the solution to MACRA’s challenges:

#1: Serves as the foundation for building hundreds of measures and pinpointing measures to go at risk on under the new MACRA legislation

What differentiates MACRA Measures & Insights from any other solution in the industry, is its unprecedented ability to help organizations decide and prioritize which measures to go at risk on in their value-based care contracts:

  • Easily adds measures from other payer’s contracts.
  • Enables users to identify measures for optimizing at-risk payments.
  • Enables users to identify populations to go at risk on.

#2: Helps organizations integrate and align on measures

MACRA Measures & Insights is built on Health Catalyst’s industry-leading data and analytics platform, with over 120 proven data source integrations (including all major EMRs, claims, and other external data). This makes it easy for different departments to align and integrate their data. MACRA Measures & Insights can quickly support virtually any regulatory reporting or analytics requirement, including any changes that might come along in the future.

#3: Displays benchmarks for comparison

MACRA Measures & Insights displays benchmarks for comparison purposes. Data is easily integrated (e.g., patient-level measures integrated into other EMRs or Health Catalyst applications to help with care gaps and delivery of care) or exported (e.g., measures data is easily exported to help with regulatory reporting requirements).

#4: Enables proactive surveillance of measures to enhance outcomes

MACRA Measures & Insights monitors the behavior, activities, and other changing information needed to influence, manage, or change outcomes. It provides multiple filtering views to drill down quickly into multiple dimensions for quick decision making:

  • Specialty
  • Group
  • Individual provider
  • Domain
  • Individual measure
  • Diagnosis group
  • Data quality

#5: Shows MIPS Performance Scores

MACRA Measures & Insights can display performance scores in three initial MIPS performance quadrants, with a “Cost” category coming soon:

  • Quality
  • Clinical practice improvement activities
  • Advancing care information

Health Catalyst MACRA Products

MACRA Measures & Insights is the foundation for building hundreds of measures and specifically pinpointing measures to go at risk on under the new MACRA legislation, helps organizations integrate and align on measures, and helps with surveillance: monitoring the behavior, activities, and other changing information to influence, manage, or direct care provision.

View Webinar on Our New MACRA Measures & Insights Product On-Demand

Dorian DiNardo, VP, introduces MACRA Measures & Insights in the webinar titled “Introducing Two New Products from Health Catalyst” at 1:00 PM (Eastern) on Thursday, February 16, 2017. See a live demo of the new MACRA Measures & Insights product, participate in a live Q & A session, and learn how MACRA Measures & Insights can help health systems:

  • Integrate hundreds of measures across financial, regulatory, and quality departments.
  • Monitor the behavior, activities, and other changing information needed to influence, manage, or change outcomes.
  • Tactically and strategically identify measures to take on risk in multi-year, value-based care contracts.

View On-Demand

Speak with Someone at Health Catalyst About MACRA Measures & Insights

To learn more about MACRA Measures & Insights, Health Catalyst, and how our solutions and products might fit your needs.

Schedule A Demo

PowerPoint Slides

Would you like to use or share with others any of the following MACRA slide presentations? Each presentation contains helpful information on understanding and getting ready for MACRA

View or download any of these presentations

Click to download

MACRA and the New Quality Payment Program FAQs

By Bobbi Brown (Vice President of Financial Engagement), Dr. Bryan Oshiro (Chief Medical Officer, Senior Vice President), Dorian DiNardo (Senior Data Architect)

Click to download

The 7 Best Ways to Prepare for MACRA Today

By Bobbi Brown (Vice President of Financial Engagement)

Click to download

How Physicians Can Prepare for the Financial Impact of MACRA

By Bobbi Brown (Vice President of Financial Engagement), Dr. Bryan Oshiro (Chief Medical Officer, Senior Vice President), Dorian DiNardo (Senior Data Architect)

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