The Medicare Access and CHIP Reauthorization Act (MACRA) radically changes the way Medicare pays physicians and other advanced clinicians starting in 2019 based on 2017 performance. Previously, IT leaders may have played a peripheral role in support of separate quality reporting programs, but the new program will require a coordinated effort with IT leaders at the helm of that initiative.

Although 836,000 providers nationwide will be impacted by MACRA, a recent survey of non-primary care physicians found that 50 percent do not know what the law is. Of those providers that did know about MACRA, 32 percent of those surveyed knew it only by name. This is a problem for health care organizations generally and also for IT leaders.

Why? It is very difficult for MACRA-impacted providers to fare well without loads of IT support; here are a handful of examples:

  • Providers with advanced EMR adoption won’t lose out on credit in the newly renamed meaningful use performance category, Advancing Care Information.
  • CMS provides extra credit for electronically reporting quality measure data. CMS has encouraged electronic reporting for years, and we know they’ll eventually move that dial towards requiring it as the only method.
  • Two of the four Merit-Based Incentive Payment System (MIPS) performance categories compare a provider’s standing against their peers, so performance monitoring is critical. No paper-based method will afford the opportunity to examine potential performance issues across providers.

After providers realize the importance of IT in their MACRA strategy, the demands on IT leaders could grow very quickly. To properly prepare for MACRA, we suggest the following steps for IT leaders.

Start collaborating with your quality department. Under MACRA, CMS will evaluate how well a provider performs on clinical quality measures (CQMs). This is a major change from the way quality reporting in the Physician Quality Reporting System (PQRS) works today, which is pay for reporting. IT and quality teams will need to collaborate on how clinicians can improve performance within the context of the systems where that data is captured and subsequently reported.

Align reporting methods. Today, PQRS and Meaningful Use (MU) data are reported using different submission methods. In the future, all MIPS data can be reported with a single submission mechanism. IT leaders can encourage streamlined reporting to reduce operational burden and efficiently port all data to CMS.

Assess Clinical Practice Improvement Activities (CPIAs) for IT opportunities. If the organization already provides telehealth services, that may count toward the CPIA category. IT leaders can assess the list of CPIAs proposed for use under MIPS and help clinicians to "check the box" with existing or planned IT capabilities.

As we near November, when we expect the Final Rule, IT leaders can help rally their provider groups to make sure MACRA is on the organization’s radar.

Members of Advisory Board’s Healthcare IT Advisor program can gain additional counsel on MACRA and other topics at a national meeting September 8 and 9 in Chicago.

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