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How Can Physicians Succeed Under New MACRA Regulations?

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Thought Leaders’ Corner: Chances for Success for Physicians Under Macra

Q. What Are the Chances for Success for Physicians Under MACRA? 

A. With the passage of MACRA and its creation of the Quality Payment Program, it’s clear CMS is setting a path that completely changes how physicians get paid. This new system requires physicians to demonstrate their value not from production, but by delivering higher quality care at a lower cost. And, although there are two tracks under which groups can compete, the vast majority will be competing for success under the MIPS track.

A significant amount of work will be required by physicians to not only perform, but also measure and report their performance under MIPS. Selecting which of the specialty specific metrics a group will choose to report will be a challenging process even if a group has the analytic capabilities to make a rational decision. Then there is the pure mechanics of measuring and reporting. This includes any data-gathering infrastructure that needs to be built when the chosen metrics cannot be reported using the claims submission process.

There are several ingredients to ensure success under MIPS, but two are absolute imperatives. The first is a high level of physician engagement in the program design process. Starting from day one, physician groups should involve front line physicians to avoid the risk of having their quality and reporting processes interfere with provider workflow, which can negatively impact performance.

The second imperative is aligning the incentives of each individual provider with those incentives MIPS creates for the group. Failing to have this financial alignment reach each individual physician will be a common characteristic among groups that fail under MIPS.