Are you ready for MACRA? Scorecards can help

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With Congress attempting to repeal the Affordable Care Act (ACA), and with the president issuing executive actions to roll back portions of the ACA, some in the medical community have been wondering whether the Medicare Access and CHIP Reauthorization Act (MACRA) also faces an uncertain future.

With the Centers for Medicare & Medicaid Services recently releasing rules for how MACRA will operate in 2018, medical practices, both primary care and speciality ones, must press on in preparing to address the law's requirements.

Such careful preparation is made easier by the use of scorecards that act as critical tools to help a practice track its progress toward key goals as defined by the legislation. Through the use of various scorecards, practices can increase the likelihood that they will fall among the financial winners that the law will create, and not among its losers.

Ira Nash, MD, the executive director of Northwell Health Physician Partners (NHPP), a New York area group comprising 2,800 clinicians, reports that his practice has actually been using scorecards for quite some time, initially without any connection to MACRA. However, the practice has adapted many of its scorecards to reflect MACRA’s definition of items to be measured and its requirements.

Catching a problem

Nash provided one example of how internal scorecards helped his practice improve in terms of the data it would submit to regulators. The administrators at NHPP observed that mammography rates among their patients seemed lower than the clinicians thought those rates actually were. “We found that part of the problem was that the women were getting mammograms outside the system and doctors weren’t correctly documenting in the record that they had received an outside mammography report.”

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As a result, management chose to relieve doctors of the task of making sure that outside mammography reports were entered correctly.

“The result, of course, was that the mammography rates went up,” says Nash. “It wasn’t that more women were getting mammograms. Our process was more consistent and less consumptive of physician time and attention.”

Next: Scorecards should reflect the regulations

“We have been tracking and reporting on our quality measures and meaningful use for years,” he says. “More recently, we have consolidated our various reports into a projection of our anticipated performance under MACRA.”

At NHPP, in addition to generating scorecards about clinicians’ performance with regard to quality, productivity and patient experience, the practice also uses other scorecards for management purposes. They cover various operational metrics such as charge lag, days in accounts receivable and percent collection, as well as patient access measures such as the average number of days to get a new patient appointment. The practice updates the quality data and the data on patient experiences on a quarterly basis.

“Quality data are shared with clinical leadership who then share it with their staff,” says Nash. The data, updated monthly, is also available to clinicians online through a reporting tool.

Scorecards should reflect the regulations

To create scorecards, says Nash, demands a good understanding of the MACRA regulations, what metrics will be used and how they will be scored. He points out that some of the details are quite complicated, especially in a large organization such as his own, that has more than one tax identification number.

“We spent a lot of time and effort to make sure we understood how we would be evaluated on each of the major areas-quality, [advancing care information], etc.,” he says. Their next step was gathering the necessary data. At times, this meant creating new ways of collecting information that they were not routinely collecting before. “The final part of the process is about compiling and displaying the information in ways that people find useful, and which can yield insights into where performance needs to improve,” says Nash.

Nash emphasizes that using these analytical tools is not all about finding flaws. “We all tend to focus on areas of deficiency and say, ‘Oh! We have to fix that.’ But it’s also important to see who is doing what well and what we can learn from their practice that we can extend to others,” says Nash.

“The way we approach that is not necessarily punishing low performers but endeavoring instead to raise the performance of all so our patients all benefit,” he says.

Next: Provide clinicians with their data

Provide clinicians with their data

Mark Townsend, MD, medical director of operations for the Centra Medical Group Stroobants Cardiovascular Center in Lynchburg, Virginia, reports that his team has approached the Merit-based Incentive Payment System track of MACRA by building a scorecard to track performance, with a focus on key metrics that they have chosen.

Townsend offers this further guidance:

o Focus the attention of clinicians on their own personal performance. This is the strategy that will lead to greatest success.

o Remember that the Centers for Medicare & Medicaid Services will post quality scores and patients’ survey scores on its Physician Compare website. This means that a doctor’s online reputation, which has previously rested on listings at sites such as Healthgrades and Yelp, will now also depend upon information at Physician Compare.

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o Recognize that results in the areas of “advancing care information” and “resource use” will be associated with costs, and will inevitably impact physicians’ reimbursement and employability.

Townsend points out that the Advisory Board has developed and published blueprints for scorecards, which are available to Advisory Board members seeking models. Townsend also notes that MACRA includes provisions to give technical assistance to help small practices with 15 or fewer clinicians and to practices in rural or others areas that have a shortage of medical professionals.

“MACRA will change medicine and the practice of medicine,” says Townsend. “This legislation is designed to replace life in a widget factory where we were paid to work as quickly as we could, and the more widgets we produced the more we got paid. The new notion is that you are paid no only for production for how well you do your work.”