Practice Notes

Will MACRA make physicians even more accountable for cost and quality?

by Braden Lang

Several provisions in the recently released proposed rule appear to push physicians into a new world of financial accountability for quality and cost for the patients they care for.

First, and most obviously, 50% of composite scores under MIPS, which will be used in 2019 to adjust physician payments, will be determined by not only reporting, but performance on physician quality scores. Underneath that headline, however, mandates and bonuses for reporting outcome-based measures raise the stakes relative to past quality reporting systems.

Cost measures, under the Resource Use moniker, make up 10% of providers' composite score. Again, however, the devil's in the details. CMS will score this category on a variety of standards, many of which look at episodes of care that stretch across many different providers, specialties, and sites of care. Thus, even the solo practitioner reporting alone is held responsible for the cost and care variations within the network she practices in.

Over time, this lever only becomes stronger. By 2022, the contribution of Resource Use to providers' composite scores rises to 30%, and that's just a minimum. CMS has designed its clinical practice improvement and electronic health records standards to be met easily by most providers over time. As more providers meet those standards and win full points in those categories, the rules are structured to reduce their weight, shifting even greater weight to outcomes-based quality measures and total and episodic cost.

Add in strong and growing incentives for participation in true downside-risk reimbursement models, as well as flat growth for baseline fee-for-service revenues, and the trend is clear: maintaining sustainable reimbursement levels from Medicare into the future will require providers in all settings to develop much better capabilities to identify and eliminate unwanted clinical and cost variations in care, both within their own practices and the other settings where their patients receive care.

MACRA applies to all physician payments under the Medicare fee schedule. It's a huge part of their, and your, revenue. As I travel around the country and speak with executives, I'm hearing that the medical group is the best positioned to help physicians understand how to prepare for these reporting and performance requirements.

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