Five ways to move beyond MACRA and MIPS analysis paralysis

By Moshe Starkman, nThrive Senior Value-Based Reimbursement Consultant | Posted: 06/12/2017

Although MACRA* has been getting a lot of buzz this year, it appears that much of the industry is stuck in analysis paralysis, still uncertain on how to move forward. This is understandable in many ways, given the complexity of the law and resulting Quality Payment Program (QPP), which is the Centers for Medicare and Medicaid Services (CMS) initiative tied to payment reform.

To cut through the confusion and move from education to action, there are five things organizations should be doing today, not only to comply but also to avoid financial penalties and take advantage of incentives. Although 2017 has been designated as a trial year, it is time to end the procrastination, as 2018 reporting will be based on 2017 data, either hurting or helping organizations financially.

Here are five tips on how to move past MACRA analysis paralysis:

1. Commit to a plan

First and foremost, it is time to finalize your strategy. Will you participate either partially or in full? To achieve full participation, which will give you an edge competitively, you’ll need to report at least six months of data, with partial requiring a 90-day commitment. While either scenario is acceptable, it is safe to say that CMS prefers more data – not less.

2. Identify your team

To move from strategy to implementation, you’ll either need to partner with a registry or rely on internal resources. Although many IT teams may feel they are equipped to handle the requirements of QPP based on prior experience with the sustainable growth rate (SGR), which MACRA replaces, the reality is that there are many differences to consider.

3. Define data collection

The QPP quality measures require a deeper dive into the data, creating a higher degree of complexity to collect what you need. If you are hoping to rely on your Electronic Health Record (EHR) system to extract the details, evaluate this option closely, as many of the parameters may not be easily accessible, especially if they are locked in physician notes.

4. Calculate performance

Determining performance requires expertise to perform the calculations. If you and your team aren’t fully equipped to take this on, it is best to work through a registry to ensure that your reporting is accurate. When evaluating registries look beyond cost and identify a resource that can report on all measures not just some.

5. Create a submission timeline

Based on your strategy, you’ll need to map out a timeline to extract data and ensure it is ready to submit to CMS prior to the December 31 deadline, especially if participating in full. Remember, this isn’t the same as SGR. Expect a learning curve and plan for unforeseen roadblocks. Again, a good registry can help you successfully navigate challenges to report data that elevates your strengths and positions you favorably, which is key to going beyond compliance to excellence.

Remember to watch the nThrive educational webcast, “MACRA: What you should be doing NOW.” As a CMS-approved MIPS registry, we explore specific actions and more to help your organization prepare for the financial risks – and the rewards – inherent in the MACRA QPP.

*Medicare Access & CHIP Reauthorization Act