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

Value-Based Care News

One-Third of Healthcare Execs Ready for MACRA Implementation

A recent survey found that most healthcare executives feel their organizations are not prepared for full MACRA implementation, but still plan to participate.

Only 35 percent of healthcare executives said their organization developed a MACRA implementation strategy, survey says

Source: Thinkstock

By Jacqueline LaPointe

- Only 35 percent of healthcare executives said that their organization has a MACRA implementation strategy and feels prepared for the new value-based reimbursement program, according to a recent Health Catalyst and peer60 survey.

The survey of 187 healthcare professionals, including CEOs and other C-suite executives, revealed that only one-third of healthcare executives feel prepared for MACRA. Although most healthcare organizations plan to participate in MACRA, even though many are not fully prepared to tackle the Quality Payment Program’s requirements.

The Quality Payment Program’s first performance year may have started on Jan. 1, 2017, but 40 percent healthcare executives still identified quality measure compiling for regulatory reporting as the greatest MACRA implementation concern.

The second ranked MACRA implementation concern was facilitating more care coordination between providers and patients with 18 percent of healthcare C-suiters.

Healthcare executives in the recent Health Catalyst and peer60 survey pinpointed similar MACRA implementation worries as providers in a July 2016 Deloitte survey. Surveyed providers agreed that their organizations would need new capabilities to successfully implement risk-based arrangements under MACRA.

To participate in MACRA’s value-based reimbursement models, about 42 percent of providers said they needed more quality measure standardization, followed by additional analytics and other monitoring tools to track high-cost patients with 29 percent and cost measure standardization with 28 percent.

Despite some trepidation over MACRA preparedness, the Health Catalyst and peer60 survey found that most healthcare organizations expect to participate in MACRA this year, with only 5 percent of C-suite executives saying that their organization will opt out.

Larger healthcare organizations tended to report more MACRA implementation preparedness. One-third of large hospital executives said they developed a MACRA strategy for their employed providers, but have not implemented the strategy yet.

Only 26 percent of C-suite executives at small and medium hospitals selected the same response.

Approximately 33 percent of small and medium hospital executives also reported that they currently have no MACRA implementation strategy, but still plan to participate in the Quality Payment Program. Just 24 percent of large hospital C-suiters were in the same position.

Some of the top reasons for not developing a MACRA implementation strategy included the organization was still determining if MACRA would result in provider profitability and the program seemed too burdensome.

Some healthcare executives also explained that their organizations did not create a strategy because there was either not enough information on MACRA or they felt overwhelmed by the amount of MACRA information.

Healthcare executives echoed provider views on MACRA implementation readiness. A recent Kareo survey of over 170 providers revealed that 84 percent of providers are unsure how to meet Quality Payment Program requirements, but still plan to participate in the program.

Fortunately, healthcare executives and providers may not need to establish full MACRA implementation strategies in the next year that cover all Quality Payment Program requirements. In the final MACRA rule, CMS codified 2017 as a transition year and offered eligible clinicians four flexible reporting tracks.

To avoid a negative 4 percent Medicare reimbursement adjustment in 2017, eligible clinicians just need to report on one quality performance measure, one improvement activity, or the required advancing care information measures by March 31, 2018.

Even though most healthcare executives did not report a MACRA implementation plan, many were still confident that the Quality Payment Program would financially benefit providers.

Roughly two-thirds of small and medium hospital executives reported that they expect their employed providers to qualify for a financial bonus under MACRA or at least break even, regardless of their progress with developing a MACRA implementation strategy.

Only one small hospital executive anticipated receiving a financial penalty under MACRA and nine stated they were unsure how MACRA payments would affect their employed providers.

Large hospital executives voiced similar MACRA provider profitability projections with 36 percent expecting employed providers to receive a bonus and only one executive predicting a penalty.

Providers in the Kareo survey, however, were more skeptical about provider profitability under MACRA. About 63 percent said that they were not sure whether MACRA would decrease their claims reimbursement revenue

“Many health systems have hit the pause button on MACRA due to a combination of factors, including its complexity, the newness of the final rule, and uncertainty about whether the new Administration will make further changes,” Health Catalyst stated on its website.

“But those marching ahead are finding that compliance is likely to benefit their organization. The bottom line is that systems can choose which measures to report from their 2017 data, even if they haven’t finalized their MACRA compliance plan, and it’s likely worth their time.”


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