MACRA QPP Knowledge Limited Among Oncology Clinicians in OCM Practices


A recent research letter highlights gaps in understanding among community oncology practices of the Medicare access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP), published in JAMA Oncology (online November 22, 2017; doi:10.1001/jamaoncol.2017.3773).

The Centers for Medicare and Medicaid Services’ proposed rule for the 2018 performance year of the QPP raises the annual threshold for the Merit-based Incentive Payment System (MIPS) to $90,000 and 200 beneficiaries. Oncologists participating in the Oncology Care Model (OCM) consistently exceed these criteria. The perceptions and understandings of oncologists about the MACRA QPP may provide insights for stakeholders in the transition to value-based care.

Chadi Nabhan, MD, MBA, Cardinal Health Specialty Solutions (Dublin, OH), and colleagues conducted a survey with oncologists, hematologists, and practice administrators (n = 355) regarding three aspects of the QPP: program knowledge, challenges to implementation, and overall impact. Among those surveyed, 31% (n = 110) were affiliated with OCM practices.

In response to familiarity with MACRA, 189 of the surveyed individuals responded, 4% (n = 8) of whom reported an in-depth knowledge, 9% (n = 16) of whom reported never hearing of it, 43% (n = 81) of whom reported being somewhat familiar, and 44% (n = 84) of whom reported recognizing the name but not being familiar with the requirements.

Researchers subsequently evaluated participants’ level of confidence regarding MACRA QPP effectiveness. Among 72 respondents, 75% (n = 54) indicated that they were not ready to cope with financial risks of hospitalizations and ED costs. Reasons for the lack of readiness to face these challenges included concerns about drug costs, human resource requirements, lack of data transparency, and technology hurdles.


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While researchers acknowledged that the representation of OCM participants include in the survey was disproportionate, the overall depth of knowledge among respondents regarding the MACRA QPP was found to be limited. This finding, they wrote, raises concerns that rank and file physicians may not be actively engaging in practice transformation. “Respondents clearly had doubts that the MACRA QPP would have a positive impact on their practices, patients, and health care in general,” researchers explained.

"There is a long history of quality care initiatives in oncology including Meaningful Use, QOPI, PQRS, among others which have often been incentivized through reimbursement differentials," Bruce Feinberg, DO, co-author of the research report, told Journal of Clinical Pathways. "They have also often been viewed as overly officious resulting in practices making them back-office functions managed by non-clinical billing and coding personnel rather than by the doctors for whom they were designed. MACRA QPP, both MIPS and OCM, may be viewed the same way resulting in practices assembling teams to manage the process rather than engage their physician personnel."

In regard to interventions for stakeholders to ensure success of the MACRA QPP in oncology, researchers suggest regional educational seminars, practice-level financial counseling, frequent assessment of measured milestones to assure success, careful monitoring of patient outcomes, and impact on overall cost of care.

"The interventions we discussed in the manuscript will likely be pursued by practice leaders to broadly engage their providers as they seek their buy-in to improve their performance and thereby prescribe for a value based healthcare system," commented Dr Feinberg.—Zachary Bessette