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What The Heck is MACRA and Why Should HR Care?

March 23, 2017

MACRA.jpg We sure love acronyms in healthcare, don't we?  Well, here's a relatively new one:  MACRA.  What is it, and why should HR care about it?

Both the move to a patient-centered model of care, and the focus on the patient experience and outcomes, have driven hospitals in recent years to rethink their talent strategies. It's no longer sufficient to find a dietary worker who can just perform the job, or a nurse with an outstanding resume and technical skills. Everyone realizes that success will require a workforce that is service-oriented, collaborative and adaptable. Much of this started with these sets of letters:

  • HCAHPS = the Hospital Consumer Assessment of Healthcare Providers and Systems, and

  • The patient satisfaction survey required by CMS = the Centers for Medicare and Medicaid Services, for all hospitals in the United States

Then we had a new set of letters that brought physician offices into the fold:

  • The CG CAHPS = Clinician & Group Consumer Assessment of Healthcare Providers and Systems surveys, which are standardized tools to assess patient perception of care provided by physicians and medical groups

There are four areas of focus on the CAHPS survey:

  1. Access to care: getting appointments, care and information when needed

  2. Physician communication: how well the provider communicates with patients

  3. Office staff: helpful, courteous, and respectful staff

  4. Global rating: patient's overall assessment of the provider

Now, you can add this to the list of acronyms:  MACRA = the Medicare Access and CHIP Reauthorization Act of 2015. At a very high level, MACRA.

  • Creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment:

    • Merit-based Incentive Payment System (MIPS), and

    • Advanced Alternative Payment Models (AAPMs); and 

  • Consolidates three existing quality reporting programs (PQRS = Physician Quality Reporting System, VBPM = Value-based Payment Modifier, and MU = Meaningful Use), plus adds a new performance category, called IA = Improvement Activities, into a single system through MIPS

If you're keeping score at home, you have:  
Got it? Good!

Withouth trying to pass the spelling bee, here's what you need to know:  Physician payment is going to, increasingly, be tied to things like quality of care, access, patient engagement in their care, and the patient experience.  All of these are impacted by the level of service provided by the practice and how the physician and staff interact with the patient.

Why should an HR professional care? Because physician practices, whether independent or part of a health system, are now in the same spot hospitals were a few years ago:  trying to figure out how to hire people who will help them to succeed in this new world. Office managers, nurses, medical assistants, advanced-practice providers, front office staff - even physicians themselves are being measured against a new standard - a standard that goes far beyond clinical and technical skills.

Physician practices have been, traditionally, slow to adopt progressive management or HR strategies and tools, but they need to get beyond that - quickly.  With regard to talent acquisition, they can learn from the success of hospitals:

  1. Do a better job defining BEHAVIORAL competencies that are important (emotional intelligence, service orientation, collaboration/teamwork, and so on);

  2. Learn to evaluate these skills during the application process and interview by utilizing healthcare-specific behavioral assessments and a structured, behavioral interviewing program (physicians are notoriously bad at choosing staff); and

  3. Create a more consistent and efficient process for attracting and selecting staff.

No matter the size, practices that can do this will succeed with programs like MACRA. Those who don't will need to get familiar with this set of letters:  R-E-D-U-C-E-D--P-A-Y-M-E-N-T.

To learn more, specifically with regard to physician hiring and development, download the whitepaper below:


Bryan Warren Bryan Warren is the President of J3 Personica, a consulting, assessment, training, and coaching firm, and a guest blogger for PSI. Bryan is an expert in progressive talent strategies, with a particular focus on leader and physician selection and development.