Black Book Identifies 10 Top MACRA Trends Challenging Providers With Value-Based Care and Quality Metrics

MACRA replaces the outdated sustainable growth rate formula in the transition from fee for service reimbursement. Black Book Research crowdsource-surveyed 8,845 physician practices from February through April 2017.

1.       The Market for MIPS Compliance Technology is Booming

77% of physician practices with 3 or more clinicians seek to buy Merit-Based Incentive Payment System Compliance Technology Solutions by Q4. “Given the magnitude of the changes, the hunt is on for the best MIPS incentive enablement resources,” said Doug Brown, Managing Partner of the survey organization Black Book Research. However, 92% of respondents were not aware of any branded technologies from vendors that support all MIPS registry measures for 2017 reporting besides their EHR.

89% said the primary reason for acquiring MIPS support software was not quality measurement, but because they can’t decipher their MACRA earning potential.

“Finding one stop solutions shop for MIPS support is becoming easier with quality measure monitoring dashboards and enterprise analytics vendors,” said Brown.

SPH Analytics scored highest in the survey of current MACRA supportive technologies in the Black Book poll of provider organizations currently collecting 2017 data sets. MIPS support technology users also identified Viewics, IBM Watson Health, Caradigm, Health Catalyst, SA Ignite, Care Cloud, Optum, Mingle Analytics, Equation Health (nThrive), Meridian Precision BI, Modernizing Medicine, DocsInk, Medeanalytics, Ingenious Med, Lightbeam, MIPSWizard and XCare in the survey process.

2.       MACRA is Sparking Ambulatory EHR Optimization

83% of users of the top 8 EHR systems are upgrading or optimizing their systems for MIPS compliance. 

EHRs can be a practice’s strongest asset in collecting and submitting data. However, 72% of practices surveyed using EHR products not considered in the top 8 largest systems (Cerner, Epic, Allscripts, eClinicalWorks, NextGen, athenahealth, Practice Fusion, and GE Healthcare) stated they were not working with their vendor to ensure they were prepared for MIPS measures and can properly report the data.

Beginning in 2018, physicians must use EHR technology that is certified for 2015 and this requirement also burdens physicians utilizing small EHR vendors that have not been 2015 certified.

“The replacement market is heavily leaning to these largest 8 EHRs from small EHR vendors and expected to increase through 2018 as some providers had previously invested in EHRs that do not acclimate to agile change at scale like MACRA demands,” said Brown. “ EHR companies are not required by MACRA to update their technology so providers are ill-equipped should the practice stick with their uncertified EHR.”

3.       MACRA Consultants are a Hot Commodity

80% of all surveyed practices agree that performing a technology inventory is essential to see how far their current EHR and other traditional data systems can take them.  “MACRA consultants are busy identifying and developing tools to support innovative projects as well as to bring clinicians on board as quickly as possible but hard to contract currently because of demand,” said Brown.

75% of practices with 3 or less physicians struggle to manage the technology basics but state they cannot afford paying a consultant in 2017.

4.       Large Practices Gear Up MACRA Resources

“Seemingly, the MACRA requirements appear fairly easy to meet, you simply attest to at least one performance improvement activity. However, the reality will be significantly more difficult as smaller practices in particular begin preparing for risk,” said Brown.

81% of independent physicians in practices of 4 or more clinicians reveal they have not grasped how to align data with the reporting measures.

5.       Outsourcing will be a last-minute MACRA play for many practices

By the end of Q2, the scramble to get programs in line will consume many physician practices. “It is imperative that providers grasp the requirements of MACRA now to ensure they put the right strategy in place, since the pace of the program only accelerates in 2018 and beyond,” said Brown.

80% of provider organizations that have not developed their MACRA strategy or plan expect to select a turnkey software or outsourcer to catch up as best they can for 2017.

22% of all providers state they banked on a delayed program implementation. 91% of those who deferred any technology planning, fear they cannot find trained or qualified IT workers to successfully participate in MACRA incentives this year.

6.       Even more Independent Physicians will be driven to Sell their Practices

MACRA payment model changes are motivating more physicians to shift from independent to employed status, as 75% of remaining independent clinicians are considering selling their practices to hospitals or group practices to eliminate the administrative burden and capital costs.

68% view MACRA as a burden or bust to their independent practice by 2020.

77% of hospital-affiliated physicians see the changes as the opportunity to increase revenue and improve patient care but 66% report being unprepared for managing and executing MACRA initiatives without hospital, IDN or group practice support.

7.       Shifting Reimbursement to those with data

In 2019, the first payment year, MIPS will take approximately $199M from eligible clinicians below the performance threshold and redistribute those funds to providers above the performance threshold. Eventually, the redistributed dollars will be equivalent to nine percent of Medicare physician payments. In addition, for the first five years, $500M in supplemental funding will be awarded each year. During this time, MIPS adjustments could add ten percent in addition to the maximum positive payment adjustment, which is three times the amount of the penalty.

64% of hospital networked physician organizations are incorporating performance incentives in provider compensation models to incentivize MIPS reporting success. 88% of hospitals surveyed report they are seeking ways to ensure individual performance scores are reflected in the compensation of the physicians they employ.

8.       Individual Physician Reputations are at risk

54% of all survey respondents were unaware that the Centers for Medicare and Medicaid Services (CMS) will publish this data on their Physician Compare website, as well as be accessible by other third-party rating systems including Yelp, Angie’s List, Health Grades and Google.

69% of the surveyed practice managers are aware they need to report on 6 quality measures yet only 22% were aware they had the opportunity to choose the metrics they believe represent strengths to the practice.

Although essential to continuous improvement and practice success, 94% were unaware or unsure of how to predict their 2017 MIPS scores.

7% of practices with 15 or fewer eligible professionals have sought support with technical assistance participating in an APM or the MIPS. Of those seeking assistance, 92% were in rural or medically underserved areas.

“As more consumers spend more out of pocket for their healthcare they are seeking much more transparency into clinical quality and the cost-value equation,” said Brown.

9.       Small and Rural Providers are Rallying for ACO inclusion

Accountable Care Organization participation by small community hospitals and small physician practices are evaluating their options in joining an ACO. ACO participants can more easily achieve high scores compared to other MIPS participants increasing the likelihood of avoiding MIPS penalties and earning an exceptional performance as MACRA requires 30% of the MIPS score to be based on resource utilization. However, Track 1 ACO participants are held accountable for their cost in their ACO, not MIPS.

67% of small practices are considering joining an ACO to avoid penalties for generally lower scores due to a lack of infrastructure. Additionally, 82% of providers in rural areas are joining ACOs to avoid MIPS penalties due to their higher cost structure.

10.   Provider Cost & Quality scrutiny propelled by MACRA

A Q4 2016 Black Book survey revealed 88% of consumers under age 44 are aware of online physician rating websites, as are 55% of consumers over age 45.

12% of all healthcare consumers said they had viewed an online physician rating site in the past year.

“In particular, hospital network physician groups are taking notice that consistently high-performance scores and ratings can be a strategic advantage over local competitors,” said Brown.

52% of large group practices, IPAs, ACOs and IDNs report starting to now administratively address how, in 2018, costs will be reported for every clinician along with results of quality measures.

About Black Book

Black Book™, its founders, management and staff do not own or hold any financial interest in any of the vendors covered and encompassed in the surveys it conducts. Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media prior to vendor notification of rating results and does not solicit vendor participation fees, review fees, inclusion or briefing charges, and/or vendor collaboration as Black Book polls vendors’ clients.

Since 2000, Black Book™ has polled the vendor satisfaction across over thirty industries in the software/technology and managed services sectors around the globe. In 2009, Black Book began polling the client experience of now over 540,000 healthcare software and services users. Black Book expanded its survey prowess and reputation of independent, unbiased crowd-sourced surveying to IT and health records professionals, physician practice administrators, nurses, financial leaders, executives and hospital information technology managers.

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Source: Black Book Research LLC