An On-the-Ground Approach to Implementing MACRA in Your Practice

An On-the-Ground Approach to Implementing MACRA in Your Practice

Guest Commentary

May 03, 2017

By Harvey D. Bichkoff, MPH, CEO, Marin Cancer Care

QPP? MIPS? APMs? Are you confused about implementing MACRA in your practice yet? As chief executive officer of Marin Cancer Care, a private oncology practice near San Francisco, CA, I’m facing the same challenges many of you are, and I’d like to share some of what has helped us navigate the significant changes to the Medicare reimbursement system.

Let’s recap the basics: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) as the new way to reimburse Medicare providers. In QPP, providers can choose between participating in the Merit-Based Incentive Payment System (MIPS) or an advanced alternative payment model (APM). More information on all of this is available in ASCO’s MACRA/QPP online tool kit.

Our quality data, and how we report it to the Centers for Medicare & Medicaid Services (CMS), determines whether or not Medicare reimburses us adequately, and then whether or not we receive a financial bonus, a 4 percent penalty, or nothing beyond typical reimbursement. As of January 1, our reporting must comply with QPP.

How do we get there from here? Most oncologists and oncology administrators are focused on taking care of patients and keeping their practices viable, no small feat these days, and the move to QPP is yet another challenge we face when working to keep our doors open for patients.

2017 is a transition year, but practices do have to report some quality data in order to avoid the financial penalty, and to test the QPP reporting system before 2018 when reporting will require a significantly heavier lift to avoid a penalty in 2020.

My practice has chosen MIPS to report our quality data. We are a medium-sized practice (10 doctors) and didn't have the bandwidth to apply for CMS’ Oncology Care Model. However, we are keeping our eye on ASCO's Patient-Centered Oncology Payment Model and may opt for it in the future, which would transition us to an APM.

Our focus this year has been on educating staff and doctors on MACRA basics, so we decided to test the system this year by reporting on one quality measure during the last 90 days of 2017. We are testing measures now to determine which one we will report. We established two oversight groups, one for medical oncology and the other for radiation oncology, consisting of administrators and doctors who are reviewing and selecting quality measures for future reporting.

We’ve learned that ASCO's Quality Oncology Practice Initiative (QOPI) program is a Qualified Clinical Data Registry, so we plan to work with QOPI and CancerLinQ over the next year to expand our reporting for the more stringent requirements in 2018. Previously, we reported our PQRS data through our local Accountable Care Organization (ACO). We met the requirements, but the data we reported related more to primary care measures. We've analyzed our Quality and Resource Use Reports (QRUR), but they weren’t too helpful for us, so we will now be reporting on cancer-related measures, which will help us when CMS starts looking at utilization and cost in 2018. I know that’s a lot of alphabet soup, but taking the time this year to learn these terms and their acronyms is important for physicians and administrators in order to speak the new language of CMS.

Other resources can help us too. We have regularly attended ASCO’s MACRA webinars and utilized staff expertise to get clarification on these complicated regulations. ASCO also has an online tool kit. Change is often difficult, but starting now and learning from each other will help make it easier.  

Mr. Bichkoff has managed medical groups and hospitals for over 30 years. He is a member of ASCO’s Clinical Practice Committee (CPC) and chairs the CPC’s Oncology Administrators Work Group.


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