MACRA: Will You be Ready?



Understanding MACRA changes are especially important for medical groups to reach and maintain the most effective and efficient versions of themselves. We are all striving to find the perfect balance to define best practices. In this blog, let’s examine a few different views on MACRA, including:



MACRA: The shift is easier if:
  • Change
  • Staying updated
  • Understanding 
  • Not complete yet
  • Components
  • Technology is needed but not enforced until 2018
  • Start now so you’re ready then
  • Embrace supporting technologies


Does Lack of Understanding = Lack of reimbursement?

The Physicians Foundation and Merritt Hawkins conducted a recent survey of physician practices. The findings included: “The majority (51.3 percent) noted that 10 percent or less of their total payments were linked to value, while only 13.1 percent had 30 percent of total payments tied to value.” Are you leaving money on the table? If you follow the new guidelines and prove you are practicing value based care you can receive higher reimbursement.


The study also found approximately 87% of providers didn’t put value on value. Not understanding that you can get money back is part of the problem. If provider groups do not find the time to understand these changes, it will hurt them financially in the long run.


In some EHRs, there are dashboards that can be created to help an organization show providers how they are doing in terms of value metrics. Organizations still need to get the word out about how value metric performance equates to dollars, but once that connection is made, the dashboards can help keep performance front and center for providers.


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With all the changes, how do we prepare? Educate yourself.

Here is a breakdown of MACRA and its moving parts. Medicare Access and the CHIP Reauthorization Act (MACRA) is the law passed to reform the Medicare payment system to reward physicians who provide higher-value care.


What we know

  • MACRA repeals the Sustainable Growth Rate (SGR) formula (which calculated payment cuts for physicians) and replaces it with a fee if there is not participation in the value based care programs. Furthermore, the SGR repeal requires MedPAC to submit reports to Congress as early as July 1, 2017.

  • Merit-based Incentive Payment (MIPS) is measured by four components. Clinical Practice Improvement (15%) measures the innovation and growth of a Practice. Quality at 30% is currently known as Physician Quality Reporting System (PQRS). Resource Use (30%) is measured by “care episode groups” that will track what type and how many procedures your practice does. The use of technology is more flexible than other pieces of pie because of the extension of the deadline to 2018. This falls under the 25% of Meaningful Use. Instead, CMS is allowing medical entities to find what works well for them and adapt to it, rather than measuring how well you can adapt to new technology.
  • Alternative Payment Models (APM) are less common and not allowed in all states. These are for low-volume threshold practices ($30,000 or less in Medicare revenue); not many will be in this grouping.


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Times are changing, technology will help you evolve

With the switch to value based care and the means of measuring included in MACRA or MIPS, keeping paper records is simply not adequate anymore. The easiest way to measure data is through technology. Don Crane, CEO of the California Association of Physician Groups says, “Data and IT are of paramount importance. This movement from volume to value requires multiple competencies, all indispensable.


If value is not measured it cannot be reimbursed. A mailed-home survey is too “post visit” for your patients to truly remember all the great parts of their visit, or for service recovery to happen in real-time. You may already be providing value but you need to be measuring it at the best possible time.


This is not to say this will be an easy climb for physician groups. There have been a multitude of changes in recent years, yet technology can help you accelerate. A flexible data gathering tool like MyRounding will provide data analysis allowing you to mine trends. But it ultimately requires you to act on these trends and solve the problems that may lie hidden at your practice. Dr. John Cuddeback, Chief Medical Informatics Officer at the American Medical Group Association says, “So first, we’ve got this data, let’s invest in analytics. Once you’ve done that, you still have to redesign the process of care, to take advantage of the analytics.”



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Still room for improvement

There are pieces of MACRA that will have a delayed start, consisting of but not limited to, July 2017 and January 2018. There will be changes and improvements. The challenge is keeping up with them all. Understanding is essential for your practice to be successful.

The goal is to improve the quality of care. How do we reach that goal?

  1. Understand and adapt to the changes.
  2. Use technology to help you analyze your practice.
  3. Make changes according to the trends the data provides.
  4. Receive the reimbursement you rightfully deserve. 

The health care industry has always been one to change in the pursuit of best practices. Now it is moving from reactive to a proactive approach of care, based completely on the value of care.


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Kate Moreland

Client Specialist, MyRounding


Kate lives in Denver, Colorado where she grew up developing passions for learning, the outdoors, and helping others. As a Client Solutions Specialist for MyRounding, Kate consults with leaders from hundreds of healthcare organizations every month. Kate completed her undergraduate study at Stetson University in DeLand, Florida.