MACRA Town Hall: Effects on Your Medicare Reimbursement

At the “MACRA [Medicare Access and CHIP Reauthorization Act ] Town Hall: Effects on Your Medicare Reimbursement” session held as part of the American Society of Clinical Oncology (ASCO) Annual Meeting, Blaise Polite, MD, MPP, University of Chicago, Illinois, described MACRA using 3 key adjectives: personal, immediate, and certain.

First, Dr Polite said the MACRA provides an opportunity to make care more personalized for patients, which he also called the primary goal of most practitioners. MACRA is immediate; how practices are performing now will have an effect on the reimbursement they receive when the law goes into full effect. Finally, MACRA is inevitable, said Dr Polite, meaning it is time to take a serious look at how your practice is functioning in order to ensure you are ready for the changes that will come with it.

Providing more background on MACRA, Dr Polite called it one of the few pieces of bipartisan legislation passed in recent years. At the moment, Medicare issues payments based largely on the volume of procedures delivered to patients, with bonuses provided when practices take part in the Physician Quality Reporting System (PQRS) and Electronic Health Record Incentive program. As part of MARCA, all of these will be combined in the Merit-Based Incentive and Payment System (MIPS), which will authorize CMS to issue payments based more on the value of care delivered.

In MIPS, practices will receive a composite score based on how they perform in quality of care, resource use, clinical practice improvement, and meaningful use of certified electronic health records technology. That score will then be compared to the national median and practices awarded a higher or lower percentage reimbursement. Dr Polite stressed that it is important that physicians immediately begin to assess how their practices are tracking these key metrics, as scores for 2019 when the program goes into full effect will be based on practices’ performances in 2017.

To address how practices and physicians can prepare for MACRA, Robin Zon, MD, FACP, Michiana Hematology Oncology PC (Mishawaka, IN) explained that ASCO has been working diligently with CMS to better understand the new program and provide commentary on how to improve it.

Dr Zon said that when she first heard about MACRA, she was “shell-shocked” and extremely worried about how she should proceed to ensure that her practice could continue to operate successfully under this new model. However, after she started learning more about MACRA, her attitude changed significantly.

She now views MACRA as an opportunity to ensure that the focus of care is on patients, and make sure that they receive care that is value-focused, personal, and effective.

To ensure this is the case, Dr Zon outlined a few key activities practices should begin doing. First, she said, start 2016 quality reporting. This can be done through the PQRS, which is a quality-reporting program that encourages individual-eligible professionals and group practices to report information on the quality of care to Medicare. How practices perform on PQRS will be a critical factor in their overall MIPS score. In addition, practices should be able to demonstrate meaningful use of electronic health records.

Also, practices should have access to their Quality and Resource Use Report scores, which show how they perform on quality and cost and is used by CMS to calculate the value-based payment modifier (VM). The VM provides bonus payments, payment pen-alties, or a neutral adjustment based on the value of care delivered.

Further, practices should begin to focus on how they perform, identifying goals and then implementing strategies to meet those goals. This could include ways to encourage physician use of electronic health records systems or cost-monitoring initiatives, such as measurements of length of stay at the hospital or a commitment to using equally effective, but lower cost drug alternatives.

Ensuring these efforts are in place will take commitment from the entirety of hospital leadership, concluded Dr Zon, including financial officers, quality, chairs, and clinical managers.

Philip J Stella, MD, St Joseph Mercy Hospital (Ann Arbor, MI), closed the session with a discussion about what ASCO’s role has been and will continue to be in the development of MACRA.

As part of the MACRA task force formed by ASCO, Dr Stella said that one of their chief concerns has been how CMS is going to execute the rule. Because cancer is so different from other professions, it can be difficult to judge quality based on the metrics used in other specialties. Indeed, the treatment and outcomes of cancer can even change based on the type, stage, and molecular structure of the disease, making it impossible to compare practices based solely on abstract data.

For this reason, ASCO is working closely with CMS to identify a set of meaningful quality measures. Thus far, CMS has approved ASCO’s Quality Oncology Practice Initiative (QOPI), an oncologist-led, practice-based quality assessment program that encourages self-examination and improvement. QOPI has more than 185 clinical measures that are highly relevant to ambulatory practice; and participation in QOPI is considered a clinical improvement activity that will raise the MIPS Composite Score.

Right now, QOPI is done manually, which can make it difficult to track and use efficiently, but an electronic QOPI resource is currently being tested and developed, with the goal of giving practices access to their scores in real time. 

Therefore, since this is one of the few oncology-centric quality measurement tools, practices may wish to consider pursing certification.

Dr Stella added that ASCO is preparing to launch a number of other initiatives aimed at educating providers and giving them access to other resources that will help them succeed under this new model. These include workshops and webinars that will be available at future meetings and online, with information pertaining to quality tracking and the MACRA program. 

Also, ASCO will be holding a meeting dedicated specifically to MACRA in March 2017. Finally, Dr Stella said that he and the task force will continue to work with Congress, state leaders, and CMS to ensure that oncologists have a robust number of appropriate quality measures from which to choose.

For now, it is important that physicians recognize the changes that will be coming with MACRA and begin to take steps that will help them be ready once metrics begin being tracked in 2017, the first measurement year.