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MACRA Implementation Will be Difficult Without Meaningful Quality Measures


“Overall, at the general population level, I've been actually surprised as to how well people understand it."

Though there is widespread uncertainty about healthcare’s MACRA preparedness, one Mayo Clinic expert believes most institutions at least understand the bill.

“Overall, at the general population level, I've been actually surprised as to how well people understand it,” Nilay Shah, PhD, told Healthcare Analytics News™. He is deputy director of research at Mayo’s Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Still, understanding what the bill does and having a strategy to address it are two different things. For multi-specialty group practices (like Mayo Clinic), he said, the uncertainty was more pronounced.

“Right now, I think that's what every organization is trying to figure out, their MACRA strategy: Do they go MIPs? Do they go all Advanced Alternative Payment model? What fits in what buckets?” Shah said. “I can't imagine a single organization where it's not a big area of focus right now.”

He said larger institutions clearly had a better overall understanding, in his experience. But he also commended the CMS for its willingness to work with smaller health systems, and said that the website the agency had put together to inform decision makers was far more intuitive than having to page through the legislation itself.

“They really do have a nice website to make good sense of it, but there's so many measures. Which measures do you pick why would you pick one measure versus another? What would the impact on payments be if you picked one versus another?” he asked.

The problem, to Shah, is a recurring one: Without a consensus on the meaning of quality measurements, developing a MACRA strategy can be exceedingly difficult. That consensus is needed, “instead of saying, ‘Oh, there's all these measures—hundreds of measures. Pick a few and report on them.’”

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