Most physicians involved in practice decision-making do not feel well prepared to participate in MACRA's Quality Payment Program (QPP), according to a report released Wednesday by the American Medical Association (AMA) and KPMG.
Under MACRA's QPP, which took effect in 2017, eligible professionals can choose from two payment tracks:
- The Advanced Alternative Payment Model (APM) track, for clinicians who take on a significant portfolio of Advanced APMs, which include risk-based ACO models; or
- The Merit-based Incentive Payment System (MIPS) track, for providers who are reimbursed largely through fee-for-service.
Eligible providers who participate in MIPS in 2017 will receive penalties or bonuses of up to 4 percent beginning in 2019. That percentage will rise incrementally until it reaches 9 percent in payment year 2022.
Eligible providers subject to the requirements are:
- Certified registered nurse anesthetists;
- Clinical nurses specialists;
- Nurse practitioners;
- Physicians; and
- Physician assistants.
CMS has called 2017 a "transition" year for the program. Providers who were ready to begin participating in the programs could start collecting performance data on Jan. 1. Providers who were not yet prepared to participate have until Oct. 2 to begin collecting performance data. Providers participating in the program for the 2017 reporting year must submit all data, regardless of when collection began, to CMS by March 31, 2018.
CMS last week released a proposed rule that would reduce the number of clinicians who would be subject to MACRA's reporting requirements in 2018. CMS in the rule proposed increasing the eligibility threshold for MIPS to providers who bill Medicare Part B for more than $90,000 or who care for more than 200 unique Medicare Part B beneficiaries annually. The eligibility threshold for 2017 was billing at least $30,000 in Medicare Part B revenue or treating more than 100 Medicare Part B beneficiaries annually.
The report is based on responses from 1,000 physicians to an AMA-KPMG survey conducted between April 26 and May 1, 2017. According to the report, all respondents had "some awareness of MACRA and are involved in practice decision-making related to QPP."
About 30 percent of respondents were in a solo practice or a group practice with fewer than five physicians, nearly 40 percent were in a practice with between five and 24 physicians, and fewer than 25 percent were in a practice with 25 or more physicians.
Fifty-six percent of respondents expected to participate in MIPS in 2017, 18 percent expected to participate in the APM track, and 7 percent expected to participate in the MIPS APM option, while the remainder were unsure and did not expect to participate in QPP.
Survey respondents did not include:
- Fellows or medical residents;
- Physicians who did not accept Medicare;
- Physicians employed by the federal government; or
- Physicians who provided fewer than 20 hours of patient care weekly.
According to the report, less than one in four respondents said they felt "well prepared" to meet QPP requirements in 2017, while 65 percent said they felt "somewhat prepared."
More than half of the physicians said they felt at least somewhat knowledgeable about MACRA or QPP, but only 8 percent said they felt "deeply knowledgeable" about QPP and its requirements. Knowledge of MACRA and QPP were roughly similar across different practice types, according to the report.
An overwhelming majority—90 percent—of respondents felt the reporting requirements were somewhat or very burdensome. In particular, physicians in small practices were more likely to view the reporting requirements as very burdensome, compared with those in large practices. Specifically, physicians raised concerns over:
- The detailed nature of the requirements;
- The financial cost of capturing and reporting measures;
- The time required to report; and
- The scoring of MIPS performance.
A vast majority of physicians said they needed additional educational opportunities to understand MIPS requirements. Specifically, physicians said they need to know more about:
- Compliance scoring under the quality system;
- Financial implications of the quality system; and
- Reporting requirements.
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According to the report, among the physicians who planned to participate in MIPS, 3 in 10 intended in 2017 to report the minimum amount of data required to avoid a negative payment adjustment—which is to report one quality measure, one improvement activity, or the set of required ACI measures at some point in 2017. Another 25 percent intended to report partially, which is to report one quality measure, one improvement activity, or the set of required ACI measures for at least 90 consecutive days in 2017. Another 30 percent said their practices planned to do full reporting.
About 75 percent of physicians who planned to participate in MIPS said they would report as a group, instead of as individuals.
AMA President David Barbe in a statement said that his organization has developed resources to help eligible providers meet QPP's requirements, including "a step-by-step video on minimum reporting requirements to avoid a penalty in 2019, and a payment model evaluator that offers a brief assessment of where a practice stands." Barbe said, "In just 10 steps, physicians can successfully meet the standard under MACRA. Those who are prepared to report more data can realize rewards for improvement and for delivering high-quality, high-value care."
S. Lawrence Kocot, national leader of regulatory health care insight at KPMG, said, "While progress has been made in preparing physicians for the move from volume in the fee for service payment model to value in alternative payment models, it is important that we do even more to assist physicians with the transition."
A CMS spokesperson did not respond to a request for comment on the report, according to Modern Healthcare (Terry, Medscape, 6/28; Miliard, Healthcare IT News, 6/28; Dickson, Modern Healthcare, 6/28; EHR Intelligence, 6/28; AMA release, 6/28; AMA/KPMG report, accessed 6/30).
Join us July 11 to learn more about what the MACRA proposal would mean for you
Join our experts for a webconference on July 11 at 3 p.m. ET as we share our analysis of the 1,058-page proposed rule for MACRA's QPP.
We'll provide an overview of the most important implications of the proposed rule for provider organizations; a review of key changes to the MIPS and APM tracks for the 2018 performance year; and guidance on navigating the transition to risk-based payment and the evolution of hospital-physician alignment.