CPM Spring 2019 - 24

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Features

The new law took effect in 2017, and
over 418,000 physicians nationally had
to participate in MIPS reporting or accept
significant financial penalties.

viewed MIPS as a choice between partici- on data reported to us, the financial gain for
pating in a complex, opaque and expensive these physicians in both avoided penalties
quality reporting mandate or accepting a as well as quality bonuses in their Medicare
4% Medicare Part B penalty. Many doctors Part B payments totaled $2.31 million.
suggested that they would rather go out
When The Collaborative offered Pennsylva- of business.
nia physicians with a MIPS reporting option,
the visibility of PAMED among Pennsylvania PAMED'S RESPONSE
physicians increased significantly.
In response to PAMED members' concerns, the newly-formed PAMED subsidiary,
Ultimately, 156 physicians relied on The Care Centered Collaborative, issued
The Collaborative to help meet MAC- an RFP for a MACRA reporting solution.
RA's reporting requirements. Based on This was supported by PAMED's Board
a calculation of a percentage of budget, of Trustees because the creation of The
this yielded a 340% return on PAMED's Collaborative was based on the Get in The
physician investment.
Game strategic blueprint that supported
physician-led quality reporting, as well as
Physician antipathy to MACRA peaked in the 2016 Practice Options Initiative that
2017 and 2018; while this has receded from specifically included MACRA as a rationale.
view, hostility remains high and has diluted
the positive impacts achieved by PAMED.
The Collaborative was funded by
monies taken from the PAMED EndowBoth the upside benefits of being a force ment, which had been created following
for good (helping physicians) and the the sale of PMSLIC and committed to
downsides when things go bad (a burden- generate investment income in support
some reporting mandate) have important of PAMED's mission.
implications for PAMED
The Collaborative's MACRA RFP
We conservatively estimate that a third
INTRODUCTION
emphasized pricing, quality, physician of The Collaborative's 2017 budget was
In April of 2015, Congress passed the leadership and reporting experience. By devoted to responding to MACRA. If that
"Medicare Access and Reauthorization Act" the 2nd quarter of 2017, an information portion of the budget had remained in the
(or "MACRA"). Led by the AMA, many technology company experienced in CMS Endowment and was invested in U.S. equiphysician advocacy organizations strongly Quality Reporting was selected, and steep ties, it would have likely generated a return
supported this legislation because it per- pricing discounts were negotiated. Once the of greater than 20%. In contrast, based
manently did away with the Sustainable contract was finalized, The Collaborative on our internal analysis, the investment by
Growth Rate (SGR) formula. As a com- embarked on an educational and marketing PAMED in support of MACRA through
promise, however, MACRA also expanded campaign that included electronic media, The Collaborative represented a collective
several pre-existing federal programs that webinars, CME, county society meetings return on investment to the participating
were designed to promote healthcare quality and numerous in-person promotional visits practices of 340%.
in the Medicare program.
with physicians and practice managers
throughout Pennsylvania. Repeated, if PHYSICIAN BACKLASH
In the 2016 run-up to the law's January 1, anecdotal, feedback suggested that the
While MACRA was lauded as a bipartisan
2017 implementation date, PAMED began medical community appreciated PAMED's compromise and had continuing support
to hear from many physician members about support. A survey of participating physicians from national physician organizations, the
MACRA. Their feedback suggested that a demonstrated high levels of satisfaction. For reality for frontline physicians "outside of
significant number of community-based many non-member physicians, this was the the beltway" was distinctly different. For
physicians, especially in the rural areas of first time in years that they had personally them, the threat of the SGR was traded for
the Commonwealth, were threatened by the interacted with PAMED personnel.
the reality of MACRA. National surveys
specific "MIPS" reporting requirements that
of physicians confirmed growing physician
were subsequently developed by Medicare. Return on Investment: 20% vs. 340%
anger about the program and during this
This concern was confirmed by PAMED's
Ultimately, 156 Pennsylvania physicians time, calls for modification and even
in-house membership survey, which showed participated in and completed the 2017 elimination of the program began to appear.
that hundreds of Pennsylvania physicians PAMED- supported MIPS reporting. Based

For many
non-member
physicians, this
was the first time
in years they had
personally
interacted with
PAMED.

24 Spring 2019 Central PA Medicine

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CPM Spring 2019

Table of Contents for the Digital Edition of CPM Spring 2019