Presidents Perspective The Changes Being Brought Forth by MACRA

Michigan Medicine - January/February 2017

by David Krhovsky, MD, MSMS President

This issue of Michigan Medicine highlights the Medicare Quality Payment Program (MACRA) and, given the calendar, the timing could not be more appropriate. As we enter the new year, the changes brought forth by MACRA on Jan. 1, 2017 should weigh heavily on the minds of physicians across the state. MACRA is more than a simple payment rule -- it is far-reaching, transformative policy that has the potential to fundamentally restructure health care delivery in the United States.

That statement is meant to neither scare nor excite -- just simply inform.

Like most health policy, the motives behind MACRA are well-intentioned. All players in the world of health care share the same end goal; we all want to operate in a system that provides quality, cost-effective care that produces positive outcomes for patients. Unfortunately, the complexities of reality often make that aim easier said than done. In the coming year, I'm sure we'll all come to find that MACRA is not perfect, and that's okay as long as we're willing to remain vigilant in our health care system. As members of the Michigan State Medical Society, we must be thoroughly prepared to both meets the challenges MACRA poses in the present and respond appropriately in shaping its final form in the future. And that effort starts with education.

Like many other recent health policy initiatives, MACRA serves to drive the transition away from a fee-for-service payment model to value-based reimbursement. Conceptually, a value-based payment model is admirable; physicians should be rewarded for providing exceptional quality care. But in practice, the model in which we're now operating proves onerous for physicians, patients and payers alike. Quality is elusive. Quality is variable. Quality is not easily captured or measured and therein lies the challenge for organized medicine going forward. Thankfully, it's at least a challenge that will be largely familiar to physicians everywhere.

Most of MACRA isn't new. In fact, it's fair to generally characterize MACRA as a streamlined amalgam of currently existing reporting programs and requirements. With that being said, it still requires serious scrutiny and it will undoubtedly present infrastructural and reporting challenges to all providers in 2017 and beyond. And despite being largely familiar, there's no question that the complexity of this rule is overwhelming.

With that in mind, as we begin 2017, physicians need to direct their focus to where they fit in this new model instead of trying to make sense of the full landscape. Are you exempt from MIPS? Do you want to participate as an individual or as a group? Which Improvement Activities are you in engaged in now? Answering these kinds of questions will inform your standing and immediate needs in regards to MACRA participation and compliance. And there are resources and support out there to help you get started. Between the AMA, CMS and MSMS, a wealth of materials and literature have already been produced to guide physicians through this transition including checklists, webinars and training sessions.

And as we move beyond the most pressing concerns associated with the initial implementation, the Michigan State Medical Society -- and organized medicine as whole -- needs to make sure it addresses its members concerns of this policy. Health care reform is fluid. And while MACRA is undoubtedly here to stay, there is ample room and opportunity to make improvements, and we have already experienced success in that regard.

In partnership with the American Medical Association and Blue Cross Blue Shield of Michigan, MSMS successfully petitioned CMS to modify the final rule to recognize BCBSM designated Primary Cares Homes under the QPP. This was a huge win for physicians across the state. It remains our responsibility to remain informed and respond appropriately.

As physicians, our paramount goal has, and always will be, to provide quality care to our patients. We must work to remind the regulatory arm of the U.S. health care system that when physicians have opportunity to truly listen to what our patients want and focus on their needs, the quality will follow.

With a new administration and Congress entering Washington D.C., the time is right to recommit ourselves to working with policymakers to advance reforms that promote a model which provides outstanding value to patient, providers, and payers. It's our job as physicians to step forward and be that voice for organized medicine.