“Re-Tooling” Your Practices For MACRA and Value-Based Care

June 29, 2017

By Jenna Barsky and David Parry

The Medicare Access and CHIP Reauthorization Act’s (MACRA) initial Quality Performance Program (QPP) period started January 1, 2017.

Recent survey data, however, suggests most healthcare organizations still do not have a QPP plan in place.  If you fall into that category, it is not too late to be successful but delay no further.

Get organized

MACRA is a marathon, not a sprint. It requires diligent preparation, strategic planning and operational monitoring. Form a leadership team to include physician, nursing, quality, information technology and finance members.  It is vital to have all key disciplines included to ensure the full buy-in and support of practice leadership. To be successful, physicians and clinical team members must understand that in addition to providing quality care, regulatory compliance is necessary to ensure survival of the organization.

Appoint a leader

The point person will guide the team, monitor compliance and progress, and report on the program’s status. The leader must be knowledgeable of the QPP guidelines, including clinical, financial, and technical, while taking on project management responsibilities.  S/he will work to engage members of the organization, escalate issues as needed, form task groups, and implement changes approved by the leadership team.

Develop a strategy

Value-based care is the future, and it is being jump-started with the QPP.  Your QPP strategy should focus on how to enhance quality of care, increase patient engagement, and reduce costs.  As payments move from a volume-based to quality-based methodology, it is important to select measures that are both achievable and consistent with your corporate vision and business plan. By laying the proper foundational components to succeed in the QPP, organizations will be well positioned when value-based care expands to all payors.

Address issues

Most organizations will find they need to address several issues – from both a technology and operational perspective – to optimize their QPP scores in order to succeed under value-based care. Thus, a QPP strategy will include both short-term measures – those that are realistic given current tools and processes – as well as long-term goals based on QPP program incentives, such as alternative payment models.

Creating an action plan to resolve these issues will also enable the organization to become more adept in a value-based care environment. The majority of clinicians will qualify and report under the QPP’s Merit-based Incentive Program (MIPS) in 2017, with only 5-8% of clinicians reporting under a risk-based Advanced Alternative Payment Model (AAPM).

The QPP’s implementation timeframe and incentives provide healthcare organizations the opportunity to achieve short-term measures, while “re-tooling” to meet long-term measures through enhanced clinical processes and systems. For example, while the cost category could represent 30% of the composite score, which determines payment adjustments.  Organizations should take advantage of the time to venture into optimized and new delivery models to become more efficient and lower costs, while improving quality metrics and patient care outcomes.

Certified Electronic Health Record Technology (CEHRT) has been widely installed over the past several years, but end-user adoption and benefit realization from these systems are still a work-in-progress. Workflows, system configurations, and reporting functionality frequently need significant improvement.








Evaluate your EHR and related systems to streamline what, where, how, and by whom activities are performed, including:

  • Workflow technology. Are systems easy to use and optimized to capture essential data, avoid duplicate entry, and minimize clinician documentation requirements – from patient pre-visit preparations through the depart process?
  • Do the CEHRT and related systems share and update information in real time to ensure needed information is readily available without multiple logins, clicks, or duplicate data entry?
  • Evidence-based medicine. Are useful, contextual-based rules and tools available to clinicians?
  • Tasks and skill levels. Are workflow tasks being performed by the most appropriate people, i.e., could nurse assistants perform more patient preparation and depart activities, or could nurse clinicians be more actively engaged in patient examinations and assessments?
  • Delivery model. Are “well, chronic or transitional” care visits parts of your delivery model? In addition to satisfying QPP’s “Improvement Activity” measures and helping to prepare for risk/capitated arrangements, many of these services may be billable in the current “fee-for-service” environment.
  • Patient access. Have you considered telehealth or expanding your office days/hours to increase patient access, improve quality outcomes and reduce costs attributable to emergency visits or re-admissions?
  • EHRs and related systems contain a lot of information about patients, so ensure you have effective data governance and cost-management programs with reporting tools in place to fully realize the benefits of electronically documenting patient care activities. Without tools to extract and report information from your systems, it will be difficult to know what measures to select, monitor, and make adjustments where needed.

From the Centers for Medicare and Medicaid Services (CMS), access your Quality and Resource Use Reports (QRURs) and associated tables to obtain a wealth of information about your performance in comparison to other organizations, and help identify opportunities for cost efficiencies and quality improvements.

QRURs cover information your organization has submitted for PQRS as well as other quality and cost data determined by CMS through patient claims. QRURs can be valuable tools to supplement your internal reporting systems, as well as to cross-check the validity of the data between QRURs and your internal databases. To access QRURs, visit

If you haven’t started yet – now is the time

Organizations should use the QPP’s incentives and timeframe to improve workflows and operations in order to prepare for at-risk payment and value-care models.


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