What every small practice should know about MACRA

The nearly 2,400-page final rule for the Medicare Access & CHIP Reauthorization Act (MACRA) has been reviewed by healthcare experts, and the general consensus is that it’s an improvement compared to the proposed rule, but challenges for small practices remain.

“The main thing that struck us was how flexible 2017 is,” says Ingrid Lund, Ph.D., practice manager for the Advisory Board, a Washington, D.C.,-based healthcare consulting firm. “The downside to the flexibility in 2017 means there are very reduced rewards for those that have prepared well.”

Flexibility comes in the form of “pick your path,” allowing practices to do anything from reporting one quality measure for 90 days to avoid Medicare payment penalties to reporting all required data for the year to receive a small bonus.

For many small practices, the extra flexibility means time to not just prepare for implementation, but to learn more about MACRA, says Walt Gorski, director of regulatory affairs for the American College of Physicians, who notes that about half of physicians don’t even know what MACRA is. “I look at the flexibility as an opportunity to educate physicians about this rule,” he says. “Overall, the Centers for Medicare & Medicaid Services (CMS) made great strides from the proposed rule in giving practices more options and flexibility to meet the requirements of the new program.”

Laura Wooster, MPH, interim senior vice president, public policy for the American Osteopathic Association, agrees that the extra time is crucial to get physicians ready. “Now we have a lot more time to get people educated and for them to try it out,” she says.

Small practice challenges

While experts agree that CMS listened to feedback from both medical associations and independent physicians, challenges for small practices remain.

John Meigs, Jr., MD, president of the American Association of Family Physicians, says he still has problems with the overall complexity of the rule. He is disappointed that the virtual group implementation was delayed, which was a feature that would benefit small practices by combining data for reporting purposes. And while small practices are not held accountable for the total cost of care at least for the first year, he says he has big concerns about that for future years.

Data reporting under the Merit-based Incentive Payment System (MIPS)-one of MACRA’s two paths for getting paid-requires technology that independent physicians may not have in place, which could create another obstacle to implementation. “By 2018, they will be required to have a 2015-certified electronic health record (EHR) system, and that doesn’t exist yet on the market,” says the AOA’s Wooster. “Everybody should be talking to their vendor to find out the timeline and costs. There will most likely be a high cost to upgrade.”

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