The Medicare Access and Chip Reauthorization Act (MACRA) replaces a number of value-based reimbursement programs and will use 2017 as its first reporting year. But, despite being right around the corner, a survey of healthcare professionals around the country reveals only one-third are ready. But while only 35 percent of respondents have a strategy and believe they’re prepared for MACRA, most will participate in the new program. A majority of surveyed hospitals believe MACRA will benefit their physicians (or that they’ll at least break even). MACRA is new, complicated, and rife with uncertainties given the new administration. According to the survey, the top concern for health systems is compiling MACRA quality measures. But despite the industry’s slow movement towards MACRA, the bottom line is that it’s right around the corner, so hospitals must start preparing for MACRA today.

1. Are Health Systems Ready for MACRA?
Survey Reveals the Number One MACRA
Concern and Varying Degrees of Readiness
Bobbi Brown
Dorian DiNardo

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Are Health Systems Ready for MACRA?
Health systems are hanging back from
implementing comprehensive strategies to
comply with the Medicare Access and
CHIP Reauthorization Act (MACRA), which
will use 2017 as its first reporting year.
But for those charging ahead, the news is
mostly good, according to a new Health
Catalyst®/Peer60 survey of 187 healthcare
professionals who responded to an online
survey in late 2016.

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Are Health Systems Ready for MACRA?
Respondents included 37 CEOs and 94 other C-Suite executives,
including CFOs, CIOs, CMOs, and CMIOs.
They work for organizations ranging from some of the nation’s largest
urban academic medical centers and integrated delivery networks to
small, rural critical access facilities.

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Understanding MACRA: Two Tracks and a Final Rule
MACRA consolidates and replaces a
number of value-based reimbursement
programs, including the Physician
Quality Reporting System (PQRS),
Meaningful Use, and the Value-Based
Payment Modifier (VBPM).
The new program has two tracks—
one for physician groups still largely
operating in the fee-for-service (FFS)
realm, called the Merit-Based Incentive
Payment System (MIPS) and those
practices with the bulk of their business
in alternative payment models (APMs).

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Understanding MACRA: Two Tracks and a Final Rule
Most practices won’t meet the high
bar CMS has set for the APM track,
and instead will be subject to MIPS
rules, which offer the opportunity to
earn up to an extra four percent
(or lose up to four percent) on its
reimbursement rates in 2019
(based on 2017 performance).
The carrots and sticks ramp up to
a potential nine percent gain or
loss by 2022.

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Health Systems’ Top Concern: Compiling MACRA
Quality Measures
The heavy lifting required to track and compile
MACRA measures for reporting to Medicare is
top of mind for healthcare executives.
When asked which MACRA-related activities
“pose the greatest difficulties for healthcare
organizations,” 74 out of the 187 respondents
(40 percent) ranked “compiling metrics for
regulatory reporting” as the biggest challenge.
The next biggest headache identified by survey
respondents—18 percent—was the problem of
“adjusting to greater coordination between
providers and patients.”

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Ready or Not, Most Health Systems Expect to
Participate in MACRA
Only 35 percent (65) of respondents to the Health Catalyst
survey said “we have a strategy and are well on our way to being
ready” for upcoming MACRA reporting, based on 2017 charges.
Most are giving MACRA a
pass because they do not
have sufficient Medicare
charges to justify the
program–for instance,
physicians working with
pediatric hospitals.

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Ready or Not, Most Health Systems Expect to
Participate in MACRA
Progress on MACRA strategies was,
surprisingly, slightly higher among small-
and medium-sized hospitals, despite
their relative lack of resources compared
to large hospitals and health systems.
Respondents who said they have a
MACRA strategy for their employed
providers but haven’t made much
progress implementing it included just 26
percent (31) of small- and medium-sized
hospitals compared to 33 percent (22) of
large hospitals and health systems.

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Ready or Not, Most Health Systems Expect to
Participate in MACRA

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Ready or Not, Most Health Systems Expect to
Participate in MACRA
The reasons for a lack of a MACRA
strategy were varied, with the most
common reason being that the
organization was trying to figure out if
providers could profit by participating
in MACRA.
Others said the work was too
cumbersome, or they either had too
little information on MACRA or they
were overwhelmed with too much
information.

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Most Health Systems Believe Physicians Will
Benefit from MACRA
Despite their relatively slow
movement on MACRA, few
hospitals reported being worried
that the regulations would cost
them money.
Only one small hospital
respondent said providers
expected to receive a penalty,
while nine said they weren’t sure.

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Most Health Systems Believe Physicians Will
Benefit from MACRA
The numbers were similar for large
hospitals and health systems.
Of the 45 respondents from large
hospitals and health systems who said
they have a MACRA strategy, 36 percent
(16) expected their affiliated physicians to
earn a bonus while 31 percent (14) said
they expected physicians to break even.
Just one large hospital expected their
physicians to receive a penalty, while
seven weren’t sure whether they would
benefit or not.

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Health Systems Are Marching Ahead with MACRA
Many health systems have hit the pause
button on MACRA due to a combination of
factors, including its complexity, the
newness of the final rule, and uncertainty
about whether the new Administration will
make further changes.
But those marching ahead are finding that
compliance is likely to benefit their
organization. The bottom line is that
systems can choose which measures to
report from their 2017 data, even if they
haven’t finalized their MACRA compliance
plan, and it’s likely worth their time.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA
Concern and Varying Degrees of Readiness
The 7 Best Ways to Prepare for MACRAToday
Bobbi Brown, Senior VP
How Physicians Can Prepare for the Financial Impact of MACRA
Dr. Bryan Oshiro
MACRA Solutions
Health Catalyst MACRA Resources
Introducing Health Catalyst MACRA Measures & Insights—Addresses Top Physician Concern:
Capturing Compliance Measures
Paul Horstmeier, Senior VP

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Bobbi Brown is the Vice President of Financial Engagement for Health Catalyst. Ms. Brown
started her healthcare career at Intermountain Healthcare supporting clinical integration efforts
before moving to Sutter Health and, later, Kaiser Permanente, where she served as Vice
President of Financial Planning and Performance. Ms. Brown holds an MBA from the
Thunderbird School of Global Management as well as a BA in Spanish and Education from
Misericordia University. She regularly writes and teaches on finance-related healthcare topics.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Dorian DiNardo joined Health Catalyst in July 2013. Prior to coming to Health Catalyst, Dorian
worked for PeaceHealth as a Senior Data Warehouse Developer. Dorian has a Bachelor of
Science Degree from Oregon State University and her PMP certification.