MACRA Survey Finds Oncology Physicians Unprepared for Payment Changes

A recent survey conducted by Integra Connect, a provider of technology and value-based specialty care, has found that a majority of specialty physicians, mainly oncologists and urologists, have not yet invested in operational changes that may be essential for their success under value-based care reimbursement models.

According to Charles Saunders, MD, chief executive officer of Integra Connect, most practices struggle with the electronic reporting requirements associated with Merit-based Incentive Payment Systems (MIPS) and alternative payment models (APMs) and often require manual chart audits.

“This is proving to be a significant upfront challenge in 2017,” Saunders said in correspondence with The American Journal of Managed Care^®. “This can be helped by a capable EHR [electronic health record] and registry that captures the data and reports it, although the provider must first enter the data.”

Of the 800 participants surveyed at Integra Connect’s meeting in June, 58% were oncology physicians and the remaining were urologists. All the physicians surveyed said they did not yet fully understand the impact of CMS’ Medicare Access and CHIP Reauthorization Act (MACRA). CMS has received comments from nearly 1300 stakeholders in response to some of the proposed amendments to MACRA’s Quality Payment Program for reporting requirements.

Additionally, Integra found:

• 71% physicians said they are “learning, but have a long way to go”
• 56% want to deliver savings through practice transformation
• 40% continue to use their existing tools and resources to meet MACRA requirements
• 24% continue to practice without any changes

Saunders believes that long-term success in this evolving world of healthcare delivery and reimbursement “requires practice transformation—technology investments, as well as clinical, administrative and cultural changes. CMS is ultimately looking for savings and an improved patient experience. That means identifying and managing high-risk patients, preventing avoidable admissions and ED [emergency department] visits, optimizing outcomes, expanding access, coordinating care, using care paths, and conducting quality improvement activities.” These concepts are the core of a patient-centered medical home, which he explained is a more “holistic” approach to patient care.

The survey found 3 main barriers to physician success under MIPS:

• Having the right people or skills (23%)
• A good understanding of the requirements (20%)
• Culture shift that enforces patient accountability/value-based care (19%)

When asked about CMS’ role in incentivizing practices to bring about upfront operational changes, Saunders said that the Oncology Care Model (OCM) “exemplifies the required approach.” He explained that CMS articulated a vision for practice transformation in the OCM, with specific insight on ways for practices to deliver improvements in cost, quality, and experience.

“It then provided a funding mechanism in the form of the so-called MEOS [monthly enhanced oncology service] payments, providing $160 pmpm [per patient per month] for qualifying 6-month episodes of care.” Importantly, a built-in accountability in the program ensures the MEOS payments are used by practices to enact operational change and deliver the needed cost reductions, Saunders explained.

“Private payers will be well-advised to follow CMS’ lead, and I strongly believe we will see this happen as value-based care models continue to proliferate,” he added.

On those lines, the survey found that practices are planning to invest in consulting services (25%), care coordination services (23%), and introducing new EHRs (21%). However, 62% of respondents don’t have a clear vision on the source of this investment or have not planned for it. A little more than half (51%) of the respondents, however, are aware of the shortcomings of their current EHRs in keeping up with value-based care transitions.

“We’ve purpose-built comprehensive technologies and services that support the practice activities required under value-based care models, including data integration and analytics, care coordination and management, EHRs, and practice management systems,” Saunders said about the services offered by his company for clinical practices. “They are optimized for APMs and risk management, patient engagement, and regulatory reporting for MIPS and APMs.”