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From the Consultant’s Corner 6/6/17

June 6, 2017 From the Consultant's Corner No Comments

Leverage MACRA to Support Long-Term Strategic Goals

MACRA is largely understood throughout the healthcare industry, and the majority of provider organizations are in the process of implementing their go-forward strategies. With 2017 being a transitional year, it is an essential time for healthcare organizations to think of the bigger picture and develop a long-term roadmap for 2018 and beyond.

A truly strategic approach to MACRA leverages the program to reinforce the broader goals of an organization. For example, the Clinical Practice Improvement Activities (CPIA) category details over 90 activities that can not only be used to determine your MIPS Composite Performance Score, but more importantly, support the strategic objectives of your practice. Many of these activities are likely on your project wish list.

CPIA is the area in which there is greater flexibility to utilize the MACRA program to drive operational and cultural changes. Although CPIA will only account for 15 percent of the overall MACRA score in the first year, these activities provide real opportunity to differentiate and grow your practice. For example, Expanding Patient Access is a priority for most organizations. These activities benefit the patient, but also increase practice revenues and resource productivity.

Within the nine CPIA categories, there are over 90 activities an organization can utilize, each earning a “high” or “medium” weight. The nine categories include:

  • Expanded patient access.
  • Population management.
  • Care coordination.
  • Behavioral and mental health.
  • Beneficiary engagement.
  • Achieving health equity.
  • Emergency preparedness and response.
  • Patient safety and practice assessment.
  • Participation in an APM.

An example of a CPIA activity within the Expanded Patient Access category is the use of telehealth, which is rapidly gaining popularity. While today’s reimbursement landscape regarding telehealth poses some ROI challenges from an investment perspective, it is a major patient satisfier and it also provides an organization with a real learning opportunity.

Within the Care Coordination category, CMS’ Transforming Clinical Practice initiatives are highly-weighted initiatives that also support other MIPS categories, such as quality. These are additional examples of how to strategically identify performance improvement activities to support the betterment of the practice – not just MACRA compliance.

How can an organization be sure which CPIA activities are right for them? The best approach is to identify which activities are aligned with the strategic goals of the organization. Every organization faces limited resources and competing priorities, so select activities that will achieve a strategic purpose. Also, many organizations are likely pursuing many of the CPIA activities independent of MACRA. Continuing these initiatives will not require a re-allocation of funding.

Healthcare providers have been inundated with federal regulations over the past several years (Meaningful Use, PQRS, value-based care, etc.). Selecting CPIA activities that are aligned with the strategic goals of your practice is an optimal approach that helps minimize the operational and financial burden of MACRA.

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Brad Boyd is president of Culbert Healthcare Solutions in Woburn, MA.


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