While practices are in the first year of reporting under the Medicare and CHIP Reauthorization Act (MACRA), the hard part has yet to come. That's because the first year of MACRA reporting includes flexible requirements that make it easy for practices to not get hit with any financial penalties.
In MACRA's Merit-based Incentive Payment System pathway, practices only have to report on one quality or practice improvement measure, or minimum advancing care information requirements this year, to avoid a 4 percent payment penalty in 2019
But that won't always be the case. As physicians have to provide more data, they may be feeling anxious about whether or not they need to bring on additional staff to prepare for this shift to quality-based reporting. MACRA represents a shift not only from volume to value, but has the potential to reshape a physician's staffing practices as well, depending on the direction a practice chooses to take. While larger practices may be well equipped to make the shift to the MACRA, smaller practices may find themselves less prepared.
According to the Physicians Practice 2017 Staff Salary Survey, based on more than 1,000 respondents, many physicians have already made up their minds: 87.2 percent of practices said they will not be adding additional staff to meet MACRA regulations.
Experts agree that a practice can pave their own way through this transition without hiring new staff, so long as they get adequate education and take proactive steps to prepare..
Ask the Right Questions
Whether to hire new staff for MACRA may not actually be the right question to ask, says Adam Weinstein, MD, a vice president for clinical IT services at DaVita Kidney Care, which operates nearly 2,500 dialysis centers across the U.S., and a speaker to other physicians on MACRA for the Renal Physicians' Association. "MACRA is largely about practice transformation and the question that comes is: 'What am I transforming from, and what am I transforming into?'"
He says that a practice first needs to assess the quality measures that reflect the care it offers its patients, and translate those into quantitative data. "Where your practice is today is going to be the driver of where you can go tomorrow, and thus what resources you need to get there," Weinstein says. On the most basic level, this is looking at what your practice does well and assessing your gaps and weaknesses.
After this, he suggests practices look at its EHR, especially how well it organizes data for reporting and whether a practice has a good relationship with the vendor in case issues crop up If a practice has a lot of room for improvement in this area or an already burdened administrative staff, this may be an opportunity to bring on new staff or seek educational resources for existing staff.