By now you’ve probably heard of the Medicare Access and CHIP Reauthorization Act (MACRA). With its long-anticipated final ruling in October, it has been getting attention lately. Perhaps you’ve been grouping MACRA with the rest of the overlooked acronyms of the healthcare industry. Unfortunately, this is one acronym you can’t ignore. Per the Centers for Medicare and Medicaid Services (CMS) you could lose 4 to 9 percent of your Medicare revenue between 2019 and 2022. So, what does MACRA mean for the future of healthcare? As a Healthcare administrator, here are some key things one should know about the MACRA ruling.
What does MACRA do?
It repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS). MACRA creates two new Medicare payment models for physicians with its new approach called the Quality Payment Program (QPP) that is designed to move healthcare for Medicare patients from volume to value. The two programs are the Merit-Based Incentive Payment System, or MIPS, and the Advanced Alternative Payment Model (APM). MIPS is designed for providers in traditional, fee-for-service Medicare. Advanced APM is designed for providers who are participating in specific value-based care models. Explaining how these models work can be an article in its own, so I will not visit that just yet. Regardless of the model they choose, physicians will need to report and improve quality and reduce costs.
Who will MACRA affect?
MACRA has strategic and economic impacts for physicians, hospitals and health systems, ultimately accelerating the transition to value-based care will affect everyone. In the short term, its impact will be most prominent on physicians who participate in Medicare and as practices adapt to the new quality-based payment models, the impact will expand. Because MACRA was passed with wide bi-partisan support, it is very likely to be with us for the foreseeable future regardless of a change in administration.
When does MACRA go into effect?
The new rules have already gone into effect as of January 1, 2017. Although the QPP has begun, there is still a period with less financial risk for the first two years of the program. The roadmap for the journey to providing patient-centered care is best summarized with this awesome timeline.
In all honestly, even with all of the research that I have done, I am still bamboozled by MACRA. There is still so much to learn! I’m sure we can all agree the adoption of the MACRA regulations can be complex, burdensome, and time-consuming, but organizations need to be ready. Hopefully with my article, the foundation of the what, who, and when have been answered. Lastly, since MACRA affects both the way care is delivered, and the way physicians are compensated for that care, its impact is likely to be more significant than the Affordable Care Act (ACA), which focused largely on access to insurance coverage.