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Advisory Services/ October 2017
October 12, 2017

MACRA for Small Practices

When you take into account the general complexities of MACRA, and the extensive amount of data, technology, and transformation that needs to occur, small medical practices just don’t have the human or financial resources to handle the transition easily.

The payment adjustment formula is complicated. Small practices need to understand which levers they should pull to maximize their reimbursement. Since the MIPS/APM program is highly flexible with several pathways, there is much room for confusion. It can be challenging for Physicians in small practices to determine their next steps. Additionally, in contrast to larger clinically integrated health systems, most small practices lack the resources and expertise necessary to drive performance toward value-based care in critical areas such as:

  • Patient Quality and Safety management
  • Care and utilization management
  • Data Informatics & analytics
  • Team-based care model implementation like a Patient-Centered Medical Home
  • Full spectrum network of specialist
  • Home Health, Skilled Nursing & Hospice Care

Despite these challenges, there are some important actions that Physicians and administrators in small practices can take.

Get Onboard – Accept that value-based care is becoming the new norm, as healthcare costs will continue to rise for the foreseeable future, regardless of the political climate.
Get Educated – Go online, and visit https://qpp.cms.gov/ – there you will find resources that can help you understand the compensation methodology and how reimbursement dollars will be affected now and over time, as well as, which metrics, initiatives, and competencies are required and which ones are optional.

Get Connected – Check out the ACI Fact Sheet: https://qpp.cms.gov/docs/QPP_ACI_Fact_Sheet.pdf. You will need a full suite of technology and services to meets the enormous data requirements to be successful with population health. These technologies extend well beyond an EMR that simply records patient documentation. It is imperative to understand upfront which reports and dashboards are available, and what insights and knowledge can be gleaned from your data to improve the health of populations. Furthermore, key patient-focused technologies that increase access, convenience and communication are a cornerstone of the MACRA initiative and foster patients to become more engaged in their own health. Such technologies include:

  • Patient Portals to help patients see their medical tests and lab results
  • Patient secure messaging to facilitate communication around medical advice
  • Online Scheduling help increase patient access
  • E-prescribing and medication reconciliation
  • Tele-medicine and telepsychiatry

Get Innovative – Most small practices will likely need to change the way they do business. Workflow transformation is required to arrive at the destination of value-based care. So we recommend that you:

  1. Evaluate your current office workflows to maximize preventative healthcare and close care gaps, such as recommended age-appropriate healthcare maintenance screenings and wellness exams.
  2. Reorganize the care team so that each member is used effectively and efficiently – especially when caring for high-risk, high-utilizing patients.
  3. Explore outside partners to expand your network of patients, providers, and resources to care for all populations.

The key to improved patient outcomes is focusing on capturing the right data in real-time that is accurate and relevant and using that data to create knowledge to drive action. Whether you partner with experts in the field or go it alone, you need to evaluate your population health, EMR and data strategies. An experienced partner should truly understand the challenges you face and provide solutions that meet your unique needs.

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