Making Plans for MACRA

Lori Pilla, MACRA Consulting

By Lori Pilla, Vice President, Intalere Supply Chain Solutions

MACRA is a term that has dominated talk lately throughout the healthcare industry. MACRA stands for Medicare Access and CHIP Reauthorization Act. What it is about, at its core, is value-based payment in Medicare, specifically Part B. It focuses on bringing value-based payment into the physician’s office and how physicians and other clinicians are reimbursed for the care they deliver in Medicare.

It effectively ends the universally disliked Sustainable Growth Rate (SGR) formula and gives providers new tools, models and resources to help give patients the best possible care. A continuing criticism of the SGR was that the formula was completely unsustainable and would have resulted, had it really been implemented, in a 30% cut in professional payments for physicians and clinicians taking care of our Medicare population. With MACRA, providers can choose how they want to take part based on practice size, specialty, location or patient population.

Providers must initially determine how material MACRA is to them in terms of Medicare fee-for-service. In some areas of the country, for example, Medicare is not as significant, especially fee-for-service Medicare, because it’s now Medicare Advantage. But in more rural and community healthcare settings, Medicare fee-for-service tends to be very important and a dominant component of the payment mix. In those areas, MACRA can have a huge impact in terms of payment and reimbursement over the next several years.

The imminent reality of MACRA is that 2017 is the “performance year” that will determine how participants are paid starting in 2019. What must be understood is that the failure to do anything under MACRA will immediately result in a 4% cut in reimbursement on Medicare beginning in 2019.

At an absolute minimum, for the 2017 performance year, physicians need to undertake a test path, or what MACRA is referring to as “pick a path.” As long as practices submit one quality measure or document one performance improvement activity, they can be viewed as neutral and won’t take the 4% cut for the 2019 payment adjustment year based on 2017 actions.

If you’ve been doing meaningful use for example, you also probably already have something around advancing care. Most physicians will find that they are already doing something that will get them accredited under MACRA.

If you participate in Medicare, beginning now, or in the not too distant future, you will need to forge a strategy for integrating with MACRA. The more quickly and comprehensively you understand how the new rules will affect you, and develop a game plan to address them, the better able you will be to take advantage of the new tools and resources to help give your patients the best possible care.

To learn more, download our podcast, Making Plans for MACRA or read our white paper Are You Prepared for MACRA?

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