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84% of Physicians Unsure of Quality Payment Program Conditions

Surveyed physicians state a general unawareness of MACRA Quality Payment Program requirements.

Alternative Payment Models

Source: Thinkstock

By Vera Gruessner

- As many as 84 percent of polled independent physicians and medical staff are unaware of how to meet the requirements of MACRA’s Quality Payment Program, according to a survey from Kareo. The majority of surveyed physicians, however, stated that they will be taking part in the Quality Payment Program over the coming years.

The reasoning behind healthcare providers choosing to participate in the Quality Payment Program may be due to the potential negative payment adjustments for Medicare claims. By the year 2020, providers may face a nine percent negative payment adjustment if they do not meet the requirements of the Merit-based Incentive Payment System (MIPS) or the advanced Alternative Payment Models (APMs).

The Kareo survey was conducted in October 2016 after the final rule for the MACRA Quality Payment Program was released. More than 170 physician practices participated in the survey and the majority are looking to take part in the Quality Payment Program to avoid negative payment adjustments.

The reporting period for a positive payment adjustment from the Quality Payment Program began on January 1, 2017. Healthcare providers and vendors had two and a half months to prepare if they wanted to receive a financial reward for quality improvement efforts in the MIPS or advanced APM programs.

The survey found that 41 percent of providers are unsure what MACRA regulations require of their physician practice and only four percent understood exactly what the Quality Payment Program required them to accomplish.

“At Kareo, we felt that it was important to understand how prepared our customers really were to begin participating in the Merit-Based Incentive Payment System (MIPS), which is the QPP path most of them will follow,” Dan Rodrigues, Founder and CEO of Kareo, said in a press release. “Our survey highlighted that independent practices want to comply but they are struggling with the complexity and aggressive timing of the rule.”

The survey also looked at how providers perceived the Quality Payment Program would impact their revenue cycle. As many as 63 percent of polled physicians were not sure whether MACRA requirements would decrease their overall reimbursement.

“The survey results highlight a trend we have seen at Kareo in recent years,” continued Rodrigues. “Independent practitioners want to stay independent so they want to participate in programs like MACRA and avoid possible penalties. But they need help to do it. The addition of the Pick Your Pace options in the final rule is a step in the right direction.”

The surveyed providers also felt that MACRA’s Quality Payment Program would increase reporting and administrative burden. More than 60 percent of those polled stated that reporting requirements would rise for their medical facility.

Private health insurers may need to work with their provider networks to ensure that the reporting burden of multiple value-based care payment contracts and quality improvement programs do not overwhelm physician practices. This may involve aligning quality metrics of value-based care reimbursement contracts alongside that of the MACRA Quality Payment Program.

Additionally, commercial healthcare payers could begin preparing to participate with providers in MACRA requirements through the All-Payer Combination Option, according to the Healthcare Information and Management Systems Society (HIMSS). Starting in 2021, healthcare providers will have the opportunity to participate in either the All-Payer Combination Option or the Medicare Option.

The All-Payer Combination Option allows clinicians who have taken part in advanced APMs to work with state Medicaid programs and commercial payers through Medicare Advantage plans.

There are three particular requirements for commercial payers and providers to participate in the All-Payer Combination Option. Certified Electronic Health Record technology needs to be used by all parties, quality metrics need to be comparable to the measures from MIPS, and the alternative payment model must either be a medical home in the Medicaid Medical Home Model or take on more than “nominal financial risk” for aggregate spending.

Commercial payers and providers can also take part in the “Other Payer Alternative Payment Models” as part of the Quality Payment Program. Stakeholders who take part in this APM would have more opportunity to innovate and design their own methods for reimbursing medical services and measuring the quality of care.

Health insurance companies should work with physician practices that do not have a good grasp on the requirements of the Quality Payment Program. Payers could support providers by aligning their quality metrics with that of MACRA requirements. Through the All-Payer Combination Option, insurers could also progress in their transition to value-based care reimbursement.


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