MACRA is coming

Somya Gulati
Tue 05 July 2016



We trust our doctor with the most important possession. Our health. America is home to world-class doctors. But right now, our health care system often makes it difficult for them to practice medicine the way they think is best. In many hospitals and clinics, if your doctor wants to take the time to sit down with you and learn more about your health, or help you understand your care, she doesn’t get paid. And there’s often no way to pay her for doing work that we know keeps people healthy, like preventive care and educating people to live healthier lives. Instead, our system pays for tests, treatments and procedures. Not surprisingly, this has led to more services and higher costs. And it often leads doctors and patients unsatisfied.

Over the years, different programs have tried to make things better. But change was sporadic and fragmented. We have made progress like helping the vast majority of doctors adopt electronic health records. But some of their requirements were too complicated and the fundamental goals are lost. Many doctors were frustrated and some couldn’t or didn’t want to take part. To help fix this, Congress recently passed a bipartisan bill – supported by doctors and medical groups to change how we pay for better care. This new effort is called the Medicare Quality Payment Program and is part of a broader push towards value and quality.

InnovAccer has taken detailed notes on the entire 962 page MACRA proposed rule for those who do not need to see every scenario and for those who do not like to read computer manuals end-to-end. We will bring in to provide information as much as it is helpful to suit various needs and it is always better to read a bit longer blogpost than the 40 hours of reading we had to do.

As the Medicare program moves into its Golden Years, so does the reality of the job it must do in caring for our nation’s elderly and disabled.

  • There are 10,000 new Medicare beneficiaries every day,
  • A boom generation is turning 70, and
  • The 85 and up generation is set to double over the next 10 years.
  • With the growth of Medicare beneficiaries outpacing the growth of working Americans, we need to find ways, like we do in other sectors, to deliver better care at lower costs.

There are several immediate features of the program that are all designed as improvements over today’s payment system. MACRA sunsets three disjointed programs – Physician Quality Reporting System, the Value Modifier, and the Meaningful Use program. Life just got simpler as they are replaced with a single, aligned Quality Payment Program, which will reduce reporting requirements, eliminate duplication, and reduce the number of measures. The new program wraps around changes intended to promote coordinated care at reasonable costs through a uniform Merit Based system. The system also allows physicians and other clinicians to define and advance new approaches to care for patients like medical homes, specialty models, and team-based models that improve quality, manage costs, and reward physicians in those models with additional bonuses.

The rule proposes that the first performance period would start in 2017. Payment adjustments and bonuses will begin in 2019. Medicare billing charges less than or equal to $10,000 and provides care for 100 or fewer Medicare patients in one year will NOT be subject to MIPS.  

The three simplifications in the proposed rule.

  1. Reduced burden. By one-third the number of quality metrics that need to be reported. They have aligned the measures across the reporting categories to end repetitive reporting.  Much of Advancing Care Information can be done through attestation, it’s no longer all or nothing and there are a variety of paths that can be selected by a physician practice.
  2. Simplified the process. Physicians may report as a group, and be assessed as a group across each of the performance categories. They pick how they want to report, and can use it throughout the program. They can use the core quality measures across payers too.
  3. Programs talked to each other. If physicians are in an Alternative Payment Model like an Accountable Care Organization, then their job is half done from day one. They report their quality measures using the same process they have always used for their model, plus they automatically earn credit in the Clinical Practice Improvement Activities for being in an APM. If they see a substantial number of patients through an Advanced APM, then they qualify for a 5 percent bonus.

MACRA replaces the SGR with a more predictable payment method that incentivizes value. It’s how we implement MACRA over the next 10 years that counts. We have adopted a new outside-in approach and this approach calls on us to conduct an unprecedented effort of intensive listening and learning. It is sure is a historic opportunity we have before us to change how Medicare pays for care and reversing a pattern of regulations and frustration. It will ultimately unleash a new wave of collaboration between the people who spend their lives taking care of us and those of us whose job it is to support that cause.

Having said that, we all know that change sometimes can be viewed with trepidation, especially in Health care landscape. And undoubtedly it brings a lot of transitionary and cumbersome pains along with it.  What we need to keep in mind is that MACRA is still Work-in-Progress and a lot of aspects still need to be ironed out (until November 2016). But once implemented, it will be for the betterment of the physicians, especially those in the smaller practices. In the longer term, not only will it be cost efficient but also will it make the strenuous quality reporting procedures for the physician’s, easy to deal with.

To know more updates , please Subscribe

Please enter valid .
Please enter valid .
Please enter valid comment.