The Medicare Access and CHIP Reauthorization Act (MACRA) is a high stakes regulation, especially for providers serving large Medicare populations. Their ability to collect, analyze and submit key MACRA measures will have a direct, substantial impact on their Medicare revenue stream and profits. How much of an impact?
Take two providers with annual revenues of $30 million, with $10 million from Medicare. One is among the top 10% performers and earns maximum points: It will receive $2.25 million in bonuses. The other lands in the bottom 10% of performers and earns fewer than 20 points: it will lose $625,000.
Crunching real numbers to see how MACRA could benefit the bottom line can help create impetus for MACRA initiatives. By applying strategic and out-of-the-box thinking, providers can turn MACRA into a mechanism for gaining competitive advantage in a value-based care industry. Here are the key areas to target to achieve maximum benefit under MACRA:
Develop synergies with payers.
MACRA and value-based care require more than collecting data via an electronic health record (EHR). Clinical data must be connected to the financial side of care. Providers can accomplish this most easily by building strategic partnerships with payers to leverage claims data. Here are four steps to align claims data with MACRA metrics:
Gather historical claims data that aligns with Merit-Based Incentive Payment System (MIPS) measures and weights.
Use objective criteria to categorize them, such as “meet CMS (Centers for Medicare & Medicaid Services) requirements”; “don’t meet CMS requirements”; invalid data (unreliable data).
Identify meaningful data points and trends, such as metrics on which the organization performs well when benchmarked against other providers that also support the organization’s value-based care and population health goals.
Decide what measures to report to CMS: there are more than 300 from which to choose.
Engage clinicians more effectively.
Clinicians often have two main complaints about the applications they must use at the point of care to document patient histories: the tools are too complex and they don’t enable agile, accurate capture of relevant information. Providers must understand where their point-of-care data collection processes are falling short so they can address these issues to maximize performance, especially in the MIPS Improvement Activities category. Here is why:
Users are more likely to follow each step of a process and input reliable data if the applications are intuitive and meet their needs.
When technology doesn’t support operational workflows, unnecessary steps are added to the process, resulting in decreased effectiveness, increased frustration for users and overall lack of process standardization.
When observation and data analysis are used together, one can diagnose the problem areas in the data collection activities at point of care and work on improving them.
Modernize data infrastructure and align IT systems to business workflows.
The data reported is only as good as the data collected and MACRA is all about data. To be reimbursed and receive bonus payments, a provider must report accurate information. If providers don’t collect sufficient data, have poorly indexed data or lack a single source of truth, MACRA ultimate goals will not be achieved. A weak or outdated data infrastructure is a MACRA compliance issue, and it also hampers effective integrated health management, a provider’s ability to enter into other value-based contracts, and engaging healthcare consumers. MACRA may be the immediate incentive, but providers must build their analytics strength to survive as the industry evolves. To tackle these issues, providers should:
Analyze current IT capabilities for data management and reporting for additional MIPS measures (separate from claims).
Assess maturity of internal systems.
Decide what areas to report on, based on data integrity.
Plan technological improvements that align with long-term organizational goals.
This to-do list may seem extensive for a compliance initiative. Yet the capabilities healthcare providers need to fully and efficiently comply with MACRA will position them to succeed with other value-based reimbursement programs, which will rapidly be standard in the industry for all types of patient populations. Taking these steps is an investment in a future in which the providers left standing will be those who can prove to payers, employers and healthcare consumers they deliver greater quality at lower costs.
This Perspectives series was written by Octavia Costea, Cognizant’s MACRA Service Offering Leader, and Vanessa Pawlak, Cognizant’s Regulatory Compliance Service Line Leader. For more information, please contact us @ firstname.lastname@example.org.