MACRA Rule Changes and the Challenges that Lie Ahead for All Medical Practices

Medicare Access & CHIP Reauthorization Act (MACRA) defines how Medicare will reimburse physicians in the future, with greater emphasis on quality, value and physicians taking more financial risks. This law introduces certain changes in the ways that Medicare providers get reimbursement for taking care of Medicare beneficiaries. Some of the properties of MACRA include:

  • It repeals the SGR (Sustainable Growth rate) Formula
  • It changes the way Medicare gives rewards to clinicians for value-based volume
  • It streamlines several quality programs into MIPS (merit-based incentive payment system)
  • It facilitates bonus payments for APM (Alternative Payment Models) participants

The new changes create a Quality Payment Program (QPP), which is also the final piece of guidance for MACRA 2015. The changes are set to come into effect from January 1, 2017. Under MACRA, physicians can choose one of the 2 payment methods that are based on certain performance and quality measures – Merit-based Incentive Payment System & Alternative Payment Methods.

Challenges that Lie Ahead

It is a widely acknowledged fact that making the complicated MACRA quality incentive feature work in clinical practice poses major challenges. Some of those include:

  • It will take all stakeholders to implement MACRA guidelines successfully: With the new update, it becomes essential for all the stakeholders to form new relationships across communities. This will ensure a smooth transition for all of them.
  • The pace intended for MACRA implementation is a bit too far-fetched: While MACRA guidelines are set to have some positive effects, implementing it so extensively in one go can have certain repercussions. The process could have been dealt with a bit more specifically.
  • Dedicated MACRA proficiency will be indispensable: Becoming familiar with and keeping up with an entirely new program will be difficult for day-to-day operational staff members. To deal with it, medical practitioners will need a source of accurate, reliable information as the program evolves.
  • Reporting requirements will increase with MIPS: Implementing MIPS will bring a significant burden on small medical facilitators due to extensive reporting requirements. The need is to reduce this burden and show more of meaningful quality performance metrics
  • Physicians in APMs can lose money by taking on too much of downside risk: MACRA APM implementation puts metrics in the hands of the physicians. While this can help them gain too, it has a downside too, which can push them towards losing more money instead under some provisions.
  • Implementation of Technology that continues to assume increasingly weighty roles: Many of MIPS related requirements are dependent on the use of technology. Technological advancements find their place in daily operations as well as reporting all kinds of mechanisms. This will, in turn, take the burden of manual work off shoulders of facilitators by a significant margin.

Timeline Overview

  • July 2015 – December 2015: Medicare physician payments surged by 0.5%.
  • 2016 – 2019: Medicare physician payments will continue to increase by 0.5% each year.
  • January 2019 onwards: Based on eligibility, physicians will enter either the APM or the MIPS track.
  • 2020 through 2025: Medicare physician fee-for-service payments will remain at 2019 levels with no new updates.

To get insights about MACRA updates and their implications on your healthcare practice, register for the year’s biggest CMS MACRA events.

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