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PRESIDENT’S
MESSAGE
MACRA is coming.
Are we ready?
By Dr. Jayesh Shah, 2016 BCMS President
With the repeal of the sustainable growth rate (SGR) now behind • Establish objective and timely measurement and reporting sys-
us, we thought our struggles were over. But before we could cele- tems that are simpler and less costly than those currently re-
brate our victory, MACRA (Medicare Access and CHIP Reautho- quired. The focus should be on improving care for all Medicare
rization Act) is suddenly here. Congress passed this legislation to patients, not creating yearly physician winners and losers that
completely reform the way Medicare makes physician payments. affects payment two years after care has been delivered.
The goal of MACRA is to provide better care with lower cost. It
focuses on quality, cost, technology improvement and practice im- • Use quality metrics that capture those activities that are under
provement. The stated main goal is to decrease administrative pa- the physician’s control and have been shown to improve the
perwork for physicians, according to the acting administrator for quality of care, enhance access-to-care, and/or reduce the cost
the Centers for Medicare and Medicaid Services (CMS). of care. The focus should be on metrics that are the most mean-
ingful to a practice and its patients, not on what will result in
The proposal currently plans to implement performance meas- the best “score.”
urements for both the Merit-based Incentive Payment System
(MIPS) and Alternative Payment Models (APM), which start on • Give physicians, who want to shift to value-based care, enough
Jan.1, 2017. time to make this transition in a way that benefits their patients
and does not cause undue collateral damage to their practices.
While these regulations are not final, the proposed rule was pub-
lished in April 2016 and CMS is actively listening to our concerns. • Require electronic health record vendors to build and maintain
Mr. Andy Slawit, CMS acting administrator, was at the American products that meet federal specifications rather than forcing
Medical Association meeting in June 2016 echoing many of our con- physicians to buy and constantly upgrade expensive and often-
cerns. Physicians should continue to post their comments and con- bulky systems.
cerns on the website at www.cms.gov before the comment period
ends in July 2016. The final rule is to be published by October 2016. Here is what all physicians should do.
PREPARE YOUR PRACTICE: All physicians and practice
MACRA is an innovative model with new approaches, including
models of medical home and specialty models to reduce cost. managers should review all the modules on the steps to transition
MACRA sunsets three of the existing quality programs — includ- their practice so the practice can meet the challenges of value-based
ing PQRS — into a single, aligned quality improvement program. care. https://www.stepsforward.org/
If a physician chooses the Alternative Payment Model, then the re-
quirement is decreased. MIPS allows additional opportunity for PREPARE YOUR PRACTICE. There are steps you can take
bonus payments. According to the information on the CMS web- now to prepare for the transition to MACRA next year, such as par-
site, $500 million are assigned as bonus funds for the first six years. ticipating in a qualified clinical data registry that streamlines re-
First reporting is not due until 2018. porting processes.
Adding new regulations without improving the infrastructure will MACRA TOOL KIT: AMA has prepared a Tool Kit for all
cause more frustration to physicians. MACRA’s theoretical goals are physicians to get prepared for MACRA. To access the MACRA tool
hard to translate into the reality of private practice. Physicians feel kit and additional resources and information please visit
that the measures are more an exercise of compliance than of quality https://www. ama-assn.org/go/medicare payment.
improvement. It could lead to some unintended consequences of
physician burnout and the closure of some small practices. TMA PRACTICE EDGE: Texas Medical Association has
started TMA Practice Edge which will allow small practices and
The Texas Medical Association’s MACRA specialty physicians to align themselves and form clinically-inte-
position paper www.texmed.org/macra/ grated networks and ACO’s with very little upfront cost. Please re-
specifically asks CMS to: view the following website for details. www.tmapracticeedge.com.
• Exempt physicians who have no possibility of earning more than
Stay involved and stay strong. We need strong physician leader-
it costs them to report data, and not force physicians into unac- ship to overhaul this healthcare system.
ceptably risky payment models.
Regards, Dr. Jayesh Shah
8 San Antonio Medicine • July 2016
