With the announcement and implementation of the Affordable Care Act, many things in the healthcare industry have been turned on its head. This hasn’t been for the sake of wanting change on account that it was time for change, but for seeing the skyrocketing cost of care and not necessarily getting better results. The Centers for Medicare and Medicaid Services (CMS) is a large contributor to payments and reimbursement of healthcare costs, and they have formed the idea that healthcare can be improved and costs can be reduced. As such, they created MACRA or Medicare Access and CHIP Reauthorization Act to do just that. But, you don’t just send out expectations without any follow-up, so healthcare organizations are preparing themselves for what is to come. The MACRA Readiness Assessment is a true priority for every organization.
The overall stated goals of increasing healthcare outcomes and decreasing costs is all well and good, but is very vague and has no real set standards. But, how can one organization that is struggling to keep its doors open be compared to and judged against another organization that is well-funded and has high profitability margins? Due to some careful considerations, CMS understands that not healthcare facility is on equal footing, nor do they provide the exact same care to its respective populations. Participation in MACRA takes into consideration:
- The size of the practice/organization
- The specialties offered through the practice
- Where the practice is located
- How many people the practice can and does serve
In this manner, equivalent practices are measured against one another and can be assessed for achievement or penalties. So, to prepare for implementation of MACRA, organizations must first understand whether they are participating in APM (Advanced Alternative Payment Model) or MIPS (Merit-based Incentive Payment System). Both paths should be explored and full understood before making a decision as to which system is best suited for the organization. This would be the first step in evaluating the MACRA Readiness Assessment.
No one should set out on a long journey without some serious preparations having gone into it. The same should be said with implementing MACRA into an organization: a setting up of strategies with specific goals and deadlines goes a long way toward getting everyone on board and headed in the same direction. Half the battle will be to get everyone working in unison on the same goals. Unfortunately, most everyone fights against change, whether it be on a conscious or sub-conscious level, but change can be made easier when an end objective is understood.
Know the Current Standards
Although there are many changes, many of the standards and requirements are and will still be based off of current practices. CMS doesn’t expect that costs will be cut in half overnight, nor that patients won’t be readmitted to the hospital. Instead, they will be looking at what is currently going on within each organization and compare that to numbers that are recorded down the road, along with what other comparable organizations are and have done. This also includes current use of PQRS (Physician Quality Reporting Systems), use of Electronic Health Records (EHR), and change from fee-for-service-based payments to a fee-for-performance-based payment systems. Information like this will be reported and recorded for assessment in MACRA.
As with most things handed down from the government, there is a lot of minutia and complexities involved. The best thing that can be done to understand what is coming and what will be expected will be to attending meetings and symposiums that explain all the fine print. By no means should this all be done by one person, but should be divided up between people with different expertise in different areas. Then, bringing it all back together will help to form the whole picture and to do it as well-informed participants.
Open Lines of Communication
Due to the complexities, and that some of the expectations down the road not being fully defined, there will be a need for issues to be addressed, questions to be answered thoroughly, and avenues of frustration to be tackled. Some may say that this is either not necessary or is self-evident, but this step should not be looked upon lightly as it may be the hurdle that cannot be overcome by staff members. Being held in the dark or simply being told to go along to get along creates an atmosphere of resentment, dissatisfaction and out-right impedance. There can be one person dedicated to answering questions, although he or she may not be able to answer each question or issue immediately, this concept allows everyone to know exactly who to talk to and that problems can be addressed.
Know the Current Ways of Reporting
Just as knowing current standards is essential to MACRA Readiness Assessment, knowing the current ways that reporting is being handled in an organization plays a large part into being prepared for future expectations. This might sound somewhat trivial because healthcare facilities are already reporting to CMS and other payors, but what they might not recognize is the significance of those numbers and how they play a part in finding wasteful spending and other areas which can cut costs. Data-driven decisions are how meaningful changes come about, rather than random, fly-by-night patterns drive transformations. When clear understanding of how and where numbers and information are generated and then utilized, a healthcare system can put into place real modifications that turn into real results.
Though this is a somewhat simplistic look at the MACRA Readiness Assessment and the expectations that are coming down the pike, it helps to provide a look at meaningful changes that will help both patient and professional to handle healthcare in a better way and to get healthcare costs under control.