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MACRA 2.0 and Beyond: Preparing Your Practice to Meet the Quality and Reporting Challenges

Surabhi Dangi-Garimella, PhD
At the 2017 American Society of Clinical Oncology Annual Meeting, oncologists heard from fellow experts on the best way to navigate this daunting payment reform challenge.
Explaining the cost reporting basics, Polite said that the per capita cost measures will be risk-adjusted by specialty. It currently includes 41 episode measures, none of which are oncology-related. The measures include the cost of Medicare Part B drugs, while Part D drugs have been excluded.

“CMS is still working with issues such as defining an episode, and ASCO is working with CMS to provide feedback and help develop the reimbursement model,” Polite told the audience.

He went on to urge the oncologists in the room to take concrete steps to work with CMS on QPP reporting, although in 2017, CMS has allowed practices to “pick their pace.” The options that are available include:
  • Practices that don’t participate in the QPP reporting program in 2017 will see a negative 4% payment adjustment in 2019.
  • Practices that test the program and report 1 quality measure or IA or the required ACI measures (which, Polite said should be the least a practice should do in 2017) can avoid penalties in 2019.
  • If the practice is involved in partial MIPS reporting in 2017, meaning it reports on more than 1 quality measure, or IA or more than the required ACI, it can avoid penalties and be eligible for partial positive payment adjustment in 2019.
  • Practices that take on full MIPS reporting in 2017 can avoid penalties and be eligible for partial positive payment adjustment as well as an exceptional performance bonus in 2019.

Barbara McAneny, MD, provided a historic perspective on the evolution of payment models, showing the top-down versus the bottom-up models, which are payer-driven and provider-driven, respectively. The provider-driven model, where the practice identifies problems that lead to changes with the way payers pay for care, is more patient-centric and is geared to reduce financial toxicity for patients.

“We looked at things in our clinic that we can influence, such as hospital admission and triage to manage toxicities and avoiding sending the patients to the emergency room,” McAneny said, and that resulted in the COME HOME pilot, which received a CMS funding grant.

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