Issue link: https://beckershealthcare.uberflip.com/i/674245
50 FINANCE strategy. "Independent medical groups have a degree more agency in what they do to respond to MACRA that medical groups associated with hospitals or health systems won't have," she says. 8. What can organizations do now to prepare? Mr. Belokrinitsky advises putting together a team of administrative, financial, IT and clinical staff to prepare. ough these are reimburse- ment models, all decisions have to lead with quality, he says. "at has to be reflected in the team you put together to do this. If your organization is trying to figure out how to move to these new models and no physician leadership is in the room, you are probably doing it wrong." He adds, "e second component is having tech lead- ership in the room. In some respect, moving to new reimbursement models requires determining your organization's technology road- map, such as what new tech capabilities you are going to need to stand up to interoperability." As to what these parties should do once they come to the table, Ms. Fried- man says she tells medical groups there are five key things to start with: • First, medical groups should be participating, or at the very least, getting ready to participate in existing quality and EHR programs that create the baseline of MACRA. at includes PQRS, MU and VPM. "ose programs will be rolled into MA- CRA; they are not going away," she says. • Second, she says the existence of APM and the associated bonus should be a major factor in medical groups' decisions to partici- pate in risk-based models. • ird, she again stresses the need for physician groups to get educated on which track they are likely to fall into. While not all the information is available yet, there is plenty to get started on. • Fourth, Ms. Friedman recommends executives get involved. "Executives and folks steeped in policy are likely to dig into the details. Rank-and-file clinicians are not spending all their time digesting policy," she says. For this reason, a good part of the re- sponsibility of education falls on executives' shoulders. It is their job to pass this knowledge on to clinicians because it will change the provider payment landscape. • Fih and lastly, Ms. Friedman says, "Stay tuned." ere is still a considerable amount of information to come. 9. What details have yet to come out? Much of MACRA has yet to be fleshed out at a regulatory level. Once the final rule drops, a few details to look for include which exact measures will be included in MIPS and which risk-based models will be charac- terized as APM, according to Ms. Friedman. For example, while we do know the four categories of performance for MIPS, we don't know specifically within these categories which met- rics CMS will choose to include, which will ultimately have meaning- ful implications on the payments a physician will receive, according to Ms. Friedman. Second, she says we still don't know all the requirements to be an ad- vanced APM. According to CMS, MACRA defines an APM in general as a model under section 1115A or 1866C of the Social Security Act, or a shared savings program model under section 1899 of the Social Security Act. It says eligible APMs must have quality measures comparable to MIPS measures, use certified electronic health record technology and either bear more than nominal financial risk for monetary losses or be a medical home model expanded under the Center for Medicare and Medicaid Innovation. In other words, while we know what is generally required to be an APM, we don't know yet with absolute certainty which types of risk-based models will be considered advanced APMs. However, some of what is published suggests that one-sided ACO programs, like the Medicare Shared Savings Program, won't count due to a lack of downside risk exposure, according to Ms. Friedman. ese details will be in the final rule, which does not yet have an ex- pected rollout date, according to CMS. n MARK IT DOWN July 27-28, 2016 l Fairmont, Chicago CIO/HIT + Revenue Cycle Conference Becker's 2nd Annual