The MACRA final rule: It’s time to gear up

  | October 24, 2016

To many in the healthcare community, MACRA has felt like an imposing mountain to climb: The endpoint of value-based care is well-known, but the path upward is unclear. And in a teaser announcement last month, CMS raised some doubts about whether it was truly committed to the trek.
But in its MACRA final rule, announced last week, CMS held firm to its commitment to fully implement the program in future years. Yes, the agency gave assurance that it would leave no providers behind, so long as they make the effort to participate in this massive shift in payment models. Eventually, though, everyone will be expected to make the shift to value-based care.
That will be a big burden on healthcare information technology — and on the providers who will have to use it in new and meaningful ways.
We don't know what MACRA will look like when it's fully implemented; CMS has made it clear that many details are still unknown. Yet two things are clear: First, that providers should look at 2017 as a planning and practice year, not a free pass. And second, that the time to implement the infrastructure needed for MACRA success is now.
The MACRA final rule needed to be significantly watered down from the original proposal, because our healthcare system still lacks the necessary infrastructure to truly support value-based care. Most physician offices have now adopted electronic health record systems, but these systems — many of which use outdated technology — do not include the services or functionality necessary to manage and coordinate population health.
Electronically documenting patient care might have been enough to secure government dollars under the EHR Incentive Program. But under MACRA, meaningfully using these systems will require clinicians to have and share relevant patient information, regardless of where that data originates. From coordinating patient care to tracking utilization, patient engagement, and quality reporting; providers who want to succeed under MACRA won't just need IT tools. They'll need IT partners.
Information flow is critical to long-term MACRA success. Not just the obvious information flow — sending patient information from care provider A to care provider B — but information flow across the entire care continuum. And while we use robust information ecosystems every day as we scroll through Facebook and book flights using Kayak, this environment does not exist in healthcare.
The health IT vendor community is quickly waking to this reality. Some have seen connecting the care continuum as a key strategic priority for years, while others are now catching up.
Now, the provider community would be well-advised to look at MACRA beyond the short term in 2017 and realize its own role in establishing the IT infrastructure needed for success.
Providers have the power to demand that the information truly flows through the pipes that IT vendors have laid — and they shouldn't wait until the prospect of MACRA penalties is hanging over their heads. Success under MACRA will be much easier if the infrastructure and processes are already in place to exchange patient information, coordinate with other care providers, track and report quality data, communicate with patients, and manage utilization data.
We're standing at the base of the mountain now. CMS has given clinicians a little bit more time to prepare for the climb. But they would be wise to find their Sherpas and evaluate their gear now, not once the journey starts.
Stephanie Zaremba is director of government affairs for athenahealth.

The MACRA final rule: It’s time to gear up