Barriers to MACRA Participation

Now that the first reporting year for the Medicare Access and CHIP Reauthorization Act (MACRA) has come and gone, it’s time to look at some of the real-time barriers eligible providers are facing in complying with the new law.

Since there are two reporting tracks, MIPS and APM, we’ll be diving into the issues involved with both.

Merit-based Incentive Payment System (MIPS)

By participating in MIPS, healthcare providers earn a payment adjustment based on evidence-based and practice-specific quality data.

In short, MIPS is a performance based payment adjustment to your Medicare payment based on four categories of performance that add up to a final score of 100 points.

  • Quality
  • Advancing Care Information
  • Improvement Activities
  • Cost

The final score earned for a performance year determines MIPS payment adjustments in the second calendar year after the performance year.

MIPS seems to be the most popular option for many clinicians. Though it is the most chosen option, at least initially, there are still implementation barriers providers face while integrating this new system.

Technical Issues

As with all technical advances, there are problems that occur.  

First, this is a new system for everyone to learn. From the medical assistants and nurses who have first contact with your patients to the coders and billers who finish up the records, there are new items to add, options to find and check marks to click.   

Anytime new technical requirements are introduced, there is a learning period that has a real- time impact on the overall day to day operations of any practice.

Your EHR vendor can be a partner in helping to maximize your MIPS score


MIPS requires additional training and is a learning curve for all members of the healthcare team. Because so many in the office will be directly involved with the record keeping, training is needed to ensure all information is being recorded and reported correctly.

Although training aims to increase knowledge and efficiency and decrease mistakes, it can also create its own set of issues. Even coordinating the logistics of training takes more time and effort than many providers are prepared for.

Again, you should be able to look to certified EHR vendors to provide training and support for your clinicians and staff. 

Access to Shared Data

Providers who are not part of larger organizations may find it difficult to gain needed access to shared patient information, which can decrease reporting efficiency as time and resources will have to be used to gain access to necessary data.

Unfortunately, as a result solo practitioners may start considering joining larger organizations to help with compliance and, in turn, lose the autonomy that comes with practicing solo. This is certainly a potential unintended consequence of the legislation and would be the detriment to the many patients who prefer receiving care at a small practice, where they know the staff and can be more involved in their healthcare.

Alternative Payment Methods (APM)

If providers decide not to participate in MIPS, they must participate in an advanced alternative payment model (APM) and meet certain operational, risk and patient/payment volume requirements.

An Alternative Payment Model (APM) is an approach to payments that give added incentive payments to provide high-quality, yet cost-effective care. Of note, APM’s can apply in many ways such as to specific clinical conditions, populations etc.

As you can imagine, this option holds its fair share of implementation barriers as well.

Less Readily Available Information

Though a viable second option, information is less available. For solo practitioners attempting to navigate this new law, lack of information causes issues resulting in decreased efficiency.

Loss of Clinical Autonomy

Though joining an APM decreases individual providers time and effort to implement MACRA, there is a definite sense of loss in the clinical decision making aspect.  

For many, this takes a toll on the way they feel about their chosen profession. The effects of those feelings are already being seen as the number of providers retiring early has risen and medical schools are seeing less and less students choosing Primary Care as their specialty.

Changes in the Patient Care Experience

Like every other change in the medical field, patients will feel the effects as well. Under the MACRA umbrella everyone will notice a more standardized approach to care.

Many patients have come to appreciate a more holistic approach to their care because they want to feel like their provider is caring for the whole person. With MIPS and MACRA, the quality metrics are incredibly narrow, and can be inconsistent with the type of holistic relationship many patients seek.

Providers will now have to ensure they follow certain standards of care, which may result in interactions that feel very clinical. This could be a big problem for long term patients who have become accustomed to a more casual interaction with their healthcare provider.

Some enhanced EHR solutions include MACRA reporting functionality that gives providers the autonomy of keeping their usual workflows, while the reporting engine works behind the scenes to track measures for them.  

Cost of Time Commitment

Increasingly, providers who have been working toward MACRA compliance are becoming disillusioned based on how much time the new record keeping requirements take. Some providers feel the monetary penalty is easier to deal with rather than expending more of their time and energy to comply.

Although we have covered barriers that providers are experiencing while implementing MACRA, it’s important to remember that as with any new law in medicine, there is a learning curve and it takes time for everyone to fully comply and adjust.

As mentioned before, now is the time to seek out technology and optimization solutions that will ease your MACRA compliance burden and allow you to benefit from the incentive program, while maintaining your autonomy and independence.

About the Author

Vicky Warren, once a nurse, now a freelance healthcare writer and social media coach. You can connect with her on Twitter @VickyWriting.

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