Payment & Delivery Models

Time is ticking to participate in MACRA 2017

David O. Barbe, MD, MHA , Former President

I became a physician because I saw an opportunity to improve health care in my rural community. And I see that happening daily in my exam room, working closely with patients to help them better understand their health so they can lead longer, more active and happier lives. However, transforming health care also requires that I spend a good deal of time sitting behind my computer, dealing with the administrative aspects of patient care and managing a practice.

As president of the AMA, I hear from colleagues who are perplexed by some of the policy changes coming out of Washington and who feel unprepared for those changes. As the end of the year looms this trepidation is understandable, and I can relate, but I believe we have an opportunity to work together to transform patient care, as well as the way we manage our practices.

The Medicare Access and CHIP Reauthorization Act (MACRA), passed in 2015, was one of the most significant policy changes health care has seen in the past 25 years. It repealed the flawed Sustainable Growth Rate (SGR) formula and created the Quality Payment Program (QPP) with two payment pathways for physicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). The QPP streamlines Medicare reimbursement and is intended to pay for value.

Related Coverage

Last call for MIPS reporting: 6 steps to be prepared

The AMA has been working closely with the Centers for Medicare and Medicaid Services (CMS) on how best to engage and support physicians throughout the MACRA transition. We advocated for several measures to ease the transition for physicians. First, we worked to secure a gradual transition into the programs, given the lack of time and resources facing many of our physicians. As a result, practices are allowed to pick their pace of reporting in 2017 under MIPS, and we’re sounding the mantra of “one patient, one measure, no penalty.”



Practices need to report on just one patient and one measure to avoid a 4 percent payment penalty in their 2019 Medicare reimbursement. Additionally, the AMA encouraged CMS to raise the exemption threshold to protect small practices that could not possibly recover their costs for participation.

As we approach the end of 2017, many physicians are seeking advice on where their limited time and resources are best focused at this juncture. I recommend taking steps that work for your practice. There are a wide variety of quality metrics and a range of improvement activities available for consideration.

Participation in your specialty society's Qualified Clinical Data Registry (QCDR). Physicians and groups wishing to submit MIPS data via a QCDR for 2017 should review the detailed information provided by the registry to understand the activities and performance categories they support.

Participation in the AMA STEPS Forward series. This practice-based initiative can help you identify little problems you can work to address one at a time, and the modules offer improvement strategies focused on efficiency and improving patient care. 

Investment in electronic health records (EHRs). Physicians are not being forced to upgrade EHRs in the midst of transition, but it is a good idea to think ahead to identify vendors and systems that will allow for the capture, aggregation and reporting of data within a natural workflow.

Opportunities to bring in new talent. Many practices will need to bring on additional people and it may be helpful to consider the skills and experience they have related to patient interaction, tracking and reporting.

Practice changes that improve access to care. These may include patient portals on EHRs or extended hours to help reduce avoidable emergency department visits.

I urge my fellow physicians who have not yet begun their transitions to MACRA to get started today. You can visit the AMA MACRA page, which includes a Payment Model Evaluator to help you assess which care models, reporting measures and methods are best suited for your practice. With a moderate investment, most physicians will be able to participate in a way that brings greater value to the patients they serve.

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