Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

64% of Healthcare Providers Not Ready for MACRA Implementation

A recent survey found that adapting quality reporting systems and developing a team-based effort are top MACRA implementation challenges.

More than half of healthcare providers do not feel prepared for MACRA implementation, a survey found

Source: Thinkstock

- Even though MACRA’s Quality Payment Program started on Jan. 1, approximately 64 percent of healthcare providers stated that they were either unprepared or very unprepared for MACRA implementation in a February 2017 survey by Stoltenberg Consulting.

The survey of healthcare IT professionals and C-suite executives at HIMSS17 echoed similar MACRA preparation concerns expressed in a recent peer60 and Health Catalyst survey. The earlier survey of healthcare professionals revealed that only one-third of executives feel ready for MACRA implementation.

Provider and executive worries over MACRA implementation could spell trouble for healthcare organizations that must submit at least some 2017 data to the Quality Payment Program to avoid a negative Medicare payment adjustment in 2019.

“Many felt MACRA would be delayed due to its size and enormous financial impact on physician reimbursement in the transition to value-based care,” stated Joncé Smith, Stoltenberg Consulting’s Vice President of Revenue Cycle Management. “MACRA’s Quality Payment Program (QPP) now streamlines and increases provider accountability for quality outcomes and cost reduction, but success under the program will take far more than just passive submission of claim data.”

As Smith pointed out, eligible clinicians in the Quality Payment Program must do more than just submit some quality performance data to the program. But survey respondents voiced concerns about their organizations reporting mechanisms for MACRA.

READ MORE: CMS Timelines for Stage 3 Meaningful Use, MACRA Implementation

Respondents identified modifying data management and reporting mechanisms to meet new reporting requirements as their top Quality Payment Program challenge. Thirty-one percent of healthcare professionals selected this as their greatest challenge.

The second most-selected Quality Payment Program challenge was motivating staff across the organization to “collectively work together to achieve goals,” with 29 percent of respondents.

Ensuring that the entire healthcare organization is behind MACRA implementation was also an important factor for MACRA success, the survey revealed. About 68 percent of healthcare professionals said that MACRA preparation should be a team effort. The organization’s clinical, financial, and IT departments should be part of the implementation process.

While healthcare professionals valued a team-based MACRA implementation effort, more than half of respondents (54 percent) stated that finding qualified health IT staff and support to help implementation efforts was challenging. Another 28 percent said that the process was very difficult.

“Success with MACRA requires a joint effort of IT and departmental resources to successfully combine clinical, financial and operational data,” Smith pointed out. “This effort commands not only a deep technical knowledge of how and where to extract and transform the right data, but also a solid understanding of how to integrate it in such a way that the resulting data demonstrates that an organization meets objective criteria for its chosen reporting path.”

READ MORE: What We Know About Value-Based Care Under MACRA, MIPS, APMs

Healthcare professionals found their organizations short health IT staff because of limited budgets, according to 44 percent of respondents.

Another 43 percent said that their organization could not find qualified health IT staff because job candidates lacked the necessary experience.

To help healthcare organizations overcome MACRA implementation challenges, the consulting firm offered four tips.

First, healthcare organizations should select health IT job candidates that possess a unique, rather than wide, skill set. Many organizations want IT staff with clinical, financial, and operational skills. But hiring managers should look for candidates with IT and clinical work experience.

A potential hire should also have “critical thinking, creative problem solving, and strong collaboration and communication skills across multidisciplinary teams.”

READ MORE: How MACRA Implementation Rules Affect Provider Profitability

Second, the consulting firm advised healthcare organizations to invest in additional training and support for their health IT staff.

“Instead of only recruiting new staff, healthcare organizations could develop their own qualified IT staff by investing in focused training for high-potential, less experienced employees, while seeking advisors who can offer insight and training,” the survey stated. “Experts can also offer IT project guidance across the full continuum of care from both a financial and clinical perspective, which will also develop staff skills and experience with knowledge transfer.”

Third, healthcare organizations should develop a team-based approach for MACRA implementation.

“MACRA QPP [Quality Payment Program] success requires a defined, focused team which includes IT, clinical and operational departments all led by an executive representative,” the firm explained. “By combining their expertise, team members can better capture, maintain and analyze data that demonstrates program requirement achievement maximizing reimbursement opportunity.”

Finally, healthcare organizations should also create a Quality Payment Program roadmap to guide the MACRA implementation team. The multi-year roadmap should evaluate reporting mechanisms, identify potential reporting challenges, and develop plans to overcome MACRA implementation obstacles.

“A roadmap will allow a healthcare organization to quickly adapt its MACRA program from year to year, preparing for more stringent requirements in future reporting years or transition from one reporting path to another,” the survey concluded.

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