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MACRA | Another Step in Reforming Care Delivery

Hieu Nguyen   October 17, 2016  

On Friday, the Centers for Medicare and Medicaid Services (CMS) released the much-anticipated final rule on the Quality Payment Program (QPP), which is part of the Medicare Access and CHIP Reauthorization Act of 2015 – better known as MACRA. This rule is 2,200 pages (a length that surprises no one familiar with CMS rules) and provides financial incentives—and penalties—for clinicians in the move toward value-based care.

Because this rule will affect hundreds of thousands of clinicians, I think health care communications professionals have a prime opportunity to take an active role in helping clinicians understand the requirements and explain its impact on care delivery by promoting the voices of thought leaders in the field.

I think it’s important to frame any discussion about the rule by the two tracks that clinicians can choose from:

  • For clinicians in individual or small practices, they can take part in the Merit-Based Incentive Payment System (MIPS), which continues the move toward payment for quality care and for investments that improve the patient experience
  • QPP sets up Advanced Alternative Payment Models (APMs), which award clinicians participating in organizations such as an Accountable Care Organization (ACO), by providing a 5 percent payment adjustment from 2019 through 2024

Now the final rule comes after the agency heard from nearly 100,000 attendees at their outreach sessions and received more than 4,000 comments (as CMS’ acting administrator Andy Slavitt discussed in his blog). The feedback provided seems to have online prednisone made a difference in shaping the final rule and gave clinicians a lot of flexibility, which I found somewhat surprising:

  • An estimated 380,000 clinicians could be exempt from the rule
  • Clinicians who do participate have more flexibility in MIPS; specifically, those who aren’t ready to go all-in can submit some data at first without receiving a negative payment adjustment
  • The agency is considering creating a new ACO track—ACO Track 1+—that would have lower risk levels than other APMs

To help health care providers understand these and other aspects of the final rule, communications professionals can do things such as issuing informational one-pagers, and coordinating sessions where providers and administrative staff can speak to individuals who understand the new requirements. I’ve heard experts say how important it is that clinicians understand what CMS needs since there’s more than a year’s delay between reporting data to CMS and the actual start of payment adjustments.

For health care organizations that have subject-matter experts, this is the perfect opportunity to develop thought-leadership pieces that can be placed with health trades. Communication professionals can also pitch the availability of these experts to provide interviews that give reporters an on-the-ground perspective of the rule’s impact.

This rule gives communications professionals the chance to show the value they bring to their health care organization by helping providers understand and follow the evolving reimbursement rules and by positioning their experts as industry thought leaders.


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