Report: MACRA Poses Opportunity, Significant Challenges to Oncology Practices
The implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may have an unexpected consequence for many oncology practices, according to a study from the American Society of Clinical Oncology (ASCO). The “State of Cancer Care in America: 2017” report, the latest installment in an annual publication from the ASCO, examines both opportunities and challenges for cancer care delivery in the United States.
While the report’s authors view MACRA as an opportunity for oncology practice transformation, as “MACRA spurs the development and implementation of innovative payment models in oncology care to promote and incentivize high-quality cancer care and pave the way toward value-based reimbursement,” MACRA presents many challenges as well. For example, many oncology practices will need to expand/enhance their services and data reporting to meet MACRA requirements.
According to an ASCO news release, 43 percent of physicians from all specialties receive “some portion of their reimbursement under value-based systems and 58 percent of oncology practices are using clinical pathways with a goal to improve quality and reduce cost.” However, the study found that despite preexisting use of electronic health records and participation in quality programs, many oncologists will need to ramp up services in order to meet the performance standards under the Merit-based Incentive Payment System (MIPS) and thus qualify for positive payment adjustments in 2019, according to Healthcare Finance.
Furthermore, many “physicians are unaware of MACRA reforms and are unprepared to make changes to their practice to meet its requirements.” A 2016 survey of over 500 physicians found that 50 percent had never heard of the law, while 32 percent were not familiar with the requirements—though they did recognize the name, according to the report.
The report also calls out a short timeline for implementation, new requirements, an unprepared workforce, increased financial risk and uncertainty, and limited oncology-specific alternative payment model options. “Although MACRA encourages movement away from fee for service into new payment models and alternative payment models (APMs), the rules for these payment pathways remain poorly defined, and only a limited number of oncology-specific APMs are available for oncologists who want to move to this payment pathway,” according to the report.
ASCO offers resources to aid oncology practices with the transition to MACRA at www.asco.org/macra.
Sarah Sheber is assistant editor and web editor at the Journal of AHIMA.