MACRA Regulations and Guidance

Understanding & Strategizing MACRA Regulations and Alignment

The 2019 Medicare Access and CHIP Reauthorization Act (MACRA) performance year is underway, but many physicians and healthcare organizations across the country still struggle with comprehending where they stand. According to the Health IT Industry Outlook Report, 64 percent of providers feel "unprepared" or "very unprepared" for managing and executing MACRA guidelines and initiatives.

What are MACRA Guidelines?

MACRA replaces the past outdated sustainable growth-rate (SGR) formula for physician payment, transitioning focus from fee-for-service to value-based care. Clinicians now need to pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). MACRA's Quality Payment Program (QPP) now centers on improved patient outcomes, activities for quality clinical care practices, efficient use of medical resources and the meaningful utilization of EHRs.

Providers need to jump start their MACRA implementation strategy, even if they are exempt from reporting this year, because reporting requirements only become more stringent as the reimbursement/penalty opportunity increases. No longer can they blindly submit data. Instead, providers need to effectively gather, maintain and analyze data across the patient care experience to match with the QPP measures that are most operationally effective for their organizations to meet.

How can Stoltenberg help?

Stoltenberg can help your organization achieve the following tasks throughout your MACRA roadmap:

  • Assess exemption opportunities
  • Build an understanding of the MACRA QPP requirements and reporting measures (MIPS or APM)
  • Assess current reporting capabilities and identify gaps
  • Form a dedicated governance committee charged with attaining the program's requirements
  • Develop an understanding of specific patient population measures and how to select the best ones to maximize QPP performance
  • Optimize data analytics and business intelligence technology for year-round guidance
  • Calculate potential financial impact by year based on numerous reporting scenarios