MACRA Implementation: What Is at Stake and What Is Needed
The Medicare Access and Chip Reauthorization Act (MACRA) establishes two tracks for the future of physician payment in Medicare: the Merit-Based Incentive Payment System (MIPS) and participation in Alternative Payment Models (APMs).
MIPS is essentially a complex pay-for-performance payment system that requires providers to report on measures in several categories, including quality, Advancing Care Information, Clinical Practice Improvement Activities, and Resource Use. Although the Centers for Medicare and Medicaid Services (CMS) have made some effort to streamline the reporting process, the administrative burden will still be substantial.
According to a recent national survey of physician practices, physicians and their staff currently spend, on average, 785.2 hours per physician annually, to track and report quality measures for Medicare, Medicaid, and private health insurers. Three-quarters of the surveyed practices did not feel that the measures helped them improve their care, although the average cost to a practice for spending this time is $40,069 per physician per year.
The reporting burden in MIPS should be drastically reduced in order to align with the development of meaningful performance metrics. Providers should only be assessed on and their payments linked to performance measures that improve patient care, not measures that merely conform to MIPS.