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Bringing MACRA to Cardiologists, Ready or Not

Mary Caffrey
Coverage from the American College of Cardiology Scientific Session.
With the first step in the Walter E. Washington Convention Center Thursday evening, the word “MACRA” was impossible to miss. A sign bearing the acronym for Medicare Access and CHIP Reauthorization Act, the law passed in 2015 to change the way physicians are paid, was just inside the door to greet those arriving for the 66th Scientific Session of the American College of Cardiology (ACC), taking place in Washington, DC.

ACC President Richard Chazal, MD, explained its importance in his remarks at the opening session, saying MACRA “is likely to bring the most dynamic and systematic changes that we may see in our professional lifetimes,” as Medicare—a payer of great importance to cardiologists—moves from volume-based to value-based systems.

“The early years of MACRA are going pose some very real challenges to physicians accustomed to the current system,” Chazal said.

That may be an understatement.

About a half-hour earlier, a cardiologist waiting for the opening session asked what MACRA was. When told it had to do with value-based care, he scoffed, “Oh, that!” Like many physicians, he had complaints about the functionality of electronic health records (EHR), and he was not a fan of practicing in teams, except in the operating room.

Hours later, a panel of policy all-stars presented viewpoints on making MACRA work. First, Kate Goodrich, MD, MHS, director of the Center of Standards and Quality and chief medical officer at CMS, took a roomful of cardiologists through the key decision points of MACRA for 2017:
  • First, does the physician do enough Medicare billing to even be eligible?
  • Do the physicians want to submit a small amount of data to test the waters, or commit to partial or full year of data submissions under the Merit-based Incentive Payment System (MIPS)?
  • Is the practice ready for an Advanced Alternative Payment Model (APM)?
  • Should the physician submit as an individual or part of a group?

Physicians can’t afford to not know what MACRA is, because activity happening in 2017 must be submitted a year from now, to affect payment in 2019.

Goodrich acknowledged that CMS has heard provider complaints about the first-generation programs that paved the way for MACRA. It has tried to streamline the next step into value-based payment, even “rebranding” MACRA (which Congress picked) into the Quality Payment Program.

She offered examples of MIPS participation for cardiologists and discussed APMs—both existing and forthcoming—that will be especially relevant. Cardiology lends itself to Next Generation Accountable Care Organizations, but the big change will come with cardiac payment bundles, which she listed as coming in 2018.

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