Fewer than one in four physicians involved in decision making related to quality reporting (QPP) were well prepared to meet MACRA requirements this year, according a joint report from KPMG and the American Medical Association. The KPMG/AMA report is based on a survey of 1,000 physicians about MACRA and their overall readiness to comply with the law that will change how many doctors get paid.
What is MACRA?
January 1, 2017 marked the beginning of the first performance year of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA encourages physicians to adopt value-based payment models in healthcare that connect Medicare’s reimbursement to quality and reporting.
Beginning in 2019, the QPP will adjust payment rates for physicians and other eligible health care professionals for participation in 2017 under one of two payment tracks:
1. Merit Based Incentive Payment System (MIPS), a payment system with incentives or penalties for reporting and meeting certain quality measures, demonstrating use of a certified electronic health record and other measures through the Merit-Based Incentive Payment System (MIPS); or,
2. An Advanced Alternative Payment Model(Advanced APM), a 5 percent lump sum bonus payment if the physician has a threshold portion of their revenue or patients in a qualifying Advanced Alternative Payment Model (Advanced APM).
In order to help ease the transition to this new payment system, the Centers for Medicare and Medicaid Services (CMS) created a flexible “pick your pace” reporting option for physicians. Additionally, CMS rules are likely to exclude nearly two-thirds of all clinicians from MIPS reporting in 2017 (a large portion based on low volume thresholds or
Advanced APM participation; Advanced APMs are also excluded from MIPS). Under the 2018 performance year proposed rule, even more physicians would be excluded in performance year 2018 as a result of increasing the low volume threshold.
“This survey showed that about a third of respondents are unlikely to meet the basic standard of one patient, one measure, no penalty. To help physicians meet that standard, the AMA developed and deployed resources to guide physicians toward compliance. 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,” said AMA President David O. Barbe, M.D in a statement. “In just 10 steps, physicians can successfully meet the standard under MACRA. Those who are prepared to report more data can realize rewards for improvement and for delivering high-quality, high-value care.”
Some key findings from the survey of physicians involved in practice decision-making include:
– A slight majority of respondents (51 percent) were somewhat knowledgeable about MACRA or the QPP, whereas less than one in ten (8 percent) physicians felt deeply knowledgeable about QPP and its requirements. Just over four in ten physicians surveyed (41 percent) had heard of MACRA or QPP, but did not consider themselves knowledgeable.
– Seven in ten respondents have begun preparing to meet the requirements of the QPP in 2017. Of those respondents, nearly nine in ten respondents feel somewhat prepared (65 percent) or well prepared (23 percent) to meet requirements in 2017. Of those planning to report through MIPS in 2018, only 65 percent feel prepared to meet requirements.
– Respondents indicated that the time required to report is the most significant challenge today and expect that time for reporting will continue to be a challenge in subsequent years. Respondents also emphasized challenges with understanding requirements, understanding MIPS scoring, and the cost of reporting. Of those respondents expecting to participate in MIPS in 2017, 90 percent feel MIPS requirements are slightly burdensome (37 percent) or very burdensome (53 percent).
– Previous experience in other programs, including PQRS and Meaningful Use, appears to have contributed to physician readiness for QPP; thus, getting experience now in QPP at some level has the potential to set physicians up to potentially be more successful in the future than those with no experience. However, it is particularly concerning that only 25 percent of physicians with prior reporting program experience feel well prepared for the QPP.
– However, even those who feel prepared still don’t fully understand the financial ramifications of the program. In short, they may be prepared to “check the box” of reporting requirements, but may lack the long-term strategic financial vision to succeed in 2018 and beyond. Only 8 percent of respondents feel they are “very prepared” for long-term financial success, while 58 percent feel slightly prepared and 26 percent feel not at all prepared.
The findings of the survey largely support a number of widely held assumptions about physician knowledge of and preparedness for QPP requirements:
– Some challenges are universal regardless of practice size, specialty, or previous value-based care experience, particularly the time required and the complexity of reporting.
– Physicians, especially those in small practices, need more help in preparing.
– Physicians want more alternative payment model options available to them.
– Physicians with value-based care reporting experience are more prepared and more confident about how they will perform under MIPS.
– Physicians remain deeply concerned about long-term financial ramifications of QPP.