How to Prepare for MACRA: ASCO’s Tips for Oncologists

Chase Doyle

July 2016, Vol 6, No 7 - Reimbursement


The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently eliminates the sustainable growth rate formula and provides annual payment adjustments through 2019. Although this law may ultimately stabilize Medicare physician reimbursement, oncologists are currently working to prepare for this long-term transition.

At the 2016 American Society of Clinical Oncology (ASCO) annual meeting, Robin T. Zon, MD, FACP, FASCO, Vice President and Partner, Michiana Hematology Oncology, PC, Mishawaka, IN, and Chair of ASCO’s Task Force for Clinical Pathways discussed the implications of MACRA for oncologists and provided tips for oncology practices.

“Moving forward, it’s important to think about how to reward physicians and providers while considering the professional services agreements with hospitals and commercial payer contracts,” Dr Zon said.

Preparing for 2019

To prepare for the 2019 MACRA Composite Score, she recommends the following activities.

  1. Participate in 2016 quality reporting
    To avoid 2018 penalties, providers must successfully report to the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record (EHR) Incentive Program (formerly “Meaningful Use”), and the Value Modifier. Until 2019, any applicable Value Modifier payment adjustment is separate from payment adjustments made under PQRS or the EHR Incentive Program, Dr Zon said.
  2. Review your Quality and Resource Use Reports (QRUR)
    This report, which is filed under the group’s tax identification number (TIN), will indicate performance on quality and cost. An annual QRUR will be available in the fall, after the reporting period. Currently, providers are able to obtain their respective report for 2014 and a 6-month report from 2015. “One person from your TIN must register to obtain your QRUR, which is available through the CMS [Centers for Medicare & Medicaid Services] website. This will let you know the changes that you need to make in order to not be in the penalty phase of the composite score of MACRA,” she said.
  3. Focus on performance
    It is important for providers to review quality measure benchmarks and understand what is required for above-average performance. In addition, practice strategies and clinical workflows should be implemented to help meet the chosen quality measures for PQRS and the quality and cost measures used under the Value Modifier program. As for cost measures, for example, providers should establish processes to monitor hospitalizations and to measure length of stay, while noting that it may be useful to consider medical home–type services to reduce hospitalizations.
  4. Ensure data accuracy
    Because performance is compared with similar groups across the country, the accuracy of data is vital to ensure adequate characterization. This entails confirming the National Provider Identifier for each physician. “Make sure the specialty, the address, and the group affiliation are correct, and then review your own information in Physician Compare. There are usually a bunch of errors in it, so it’s very important to download and review.”
  5. ICD-10 coding
    “As we move to a risk-adjusted world, coding to the highest level of specificity, coding all comorbidities, and coding all pertinent conditions become increasingly important,” said Dr Zon. “You also have to document this. Make sure your electronic medical record, or whatever you’re using to communicate to other physicians, is accurate and up-to-date.”

Pay for Value, Not Volume

Groups and providers currently paid by volume will have to change, because future compensation will be based on value.

MACRA represents “an opportunity for us as providers,” Dr Zon said. “We need to advocate for our patients to make sure that at the end of the day, not only are they receiving high-quality and valued care as a healthcare system would define it, but valuable care as they would see it.”

Finally, if available, physicians should make use of a patient portal and e-prescribing capabilities while meeting medication reconciliation requirements, she concluded.