MACRA is coming. The Medicare Access and CHIP Reauthorization Act finally discards 17 years of Sustainable Growth Rate gyrations for Medicare reimbursement. MACRA is an improvement over SGR, but it has its own challenges surrounding data reporting and physician quality improvement.

Robert S. Lagasse, M.D.

“There are a lot of myths around what people believe they must report under MACRA,” said Robert S. Lagasse, M.D., Professor of Anesthesiology and Director of Quality Management and Perioperative Safety at the Yale University School of Medicine. “What you must report depends on the reporting method you use. And there are a lot myths around the performance metrics that will be applied.”

Dr. Lagasse is the moderator of “Measuring Physician Performance: Metrics, Money and Myths,” which will explore the ins and outs of MACRA and the key points anesthesiologists need to know about how their performance will be measured starting in January 2017.

Many presentations on MACRA have been too general to be useful, Dr. Lagasse said. This session will focus more on the reality of where performance measurement is going, how performance measurement will impact reimbursement for health care services and what ASA needs to do as a society to keep abreast of the changes.

Jonathan P. Wanderer, M.D., Assistant Professor of Anesthesiology and Biomedical Informatics at Vanderbilt University School of Medicine and Director of the Vanderbilt Anesthesiology and Perioperative Informatics Research Division, will discuss some of the choices larger departments and divisions must make and the pitfalls they are likely to experience.

Elena N. Bukanova, M.D., Assistant Professor of Anesthesiology at Yale University School of Medicine, will discuss the nuts and bolts of creating truly useful performance-improvement measures.

“It looks like the federal government is evolving more toward return on investment than on quality improvement,” Dr. Lagasse said. “The metric had to apply to large numbers of people and it had to have severe consequences if it wasn’t done correctly.”

Fortunately, providers have options. MACRA provides for two methods of measuring performance, the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS essentially rolls up existing provider performance measurement programs into a single set of metrics. APMs are a work in progress, although accountable care organizations and a few other models are being used in some areas.

Anesthesiology, like some other specialties, is not an ideal fit for either MIPS or APMs. Many of the measures to be used are designed more for primary care than for a specialized practice.

There also are questions about the validity of many of the measures to be used. Multiple studies have shown that there is inadequate power in evaluating competency testing and other measures, Dr. Lagasse said. Yet these measures will be used, at least initially, as part of financial incentive programs.

“That is going to threaten the validity of the data submitted because the system encourages gaming,” he said. “That is not just on the side of the providers. There is gaming going on by the federal government as well. Talking about money over quality or over outcomes has been kind of taboo in this country, which is why our health care spending is so much higher than other developed countries. Yet our outcomes are no better and, in many cases, worse.”