The changes made in the healthcare space by the Federal Government over the past few years has been a concern for the family physicians and small practices. In addition, the proposed Medicare Access and CHIP Reauthorization Act (MACRA) which is scheduled to come next year have been a major source of excitement.
“This piece is not to support or oppose the act but proposes a rational dialog about its advantages when the general sense has not been very receptive.”
Family physicians and small practices fear MACRA because of its complexity (the act is almost a 1000 pages) and also for the fact that it can impact their revenue generation capabilities. The opponents of the act point out that small and medium practices lack the capital and infrastructure to implement the changes required to adapt to the new reporting requirements. But the act also has a few benefits and the most important are listed below:
Declutter the reporting
Chance for positive revenue
Departure from fee-for-service
1. Declutter the reporting:
MACRA is an attempt to declutter the complex reporting requirements and make it into one, which will reduce the burden of separate reporting. With MACRA the PQRS, Advanced care, Meaningful use are brought into one Quality Payment program QPP. Although there are two models under this program, the provider is only in either of the two.
2. Chance for positive revenue:
MACRA proposes to incentivize providers on the basis of their published rank, which will be a direct increase in their revenue, unlike the system in place now which gives no incentives but penalties. MACRA allows for positive payment adjustments, besides MACRA’s maximum potential penalty for failing to meet standards are less than the current reporting programs.
3. Clinical Integration:
MACRA Act promotes clinical integration with incentives. The model is designed to encourage practice, to provide joining efforts and to improve population health. This aspect is, what the critics like to call ‘kills individual practices’, changing the old model. Yes, the old model is being changed, and it is not just MACRA. Every new legislation, step, the procedure that CMS employs is to create this change in the system, not just MACRA. Clinical integration can improve patient care quality and lead to the reduction in cost.
4. Departure from Fee-For-Service:
This is what it all boils down to. CMS aims to reduce the amount spent on healthcare and improves the quality of care the population receives. MACRA is yet another organized step in this direction; with its strong words MACRA will allow American healthcare industry to take a giant leap in the direction of value-based service.
It will not be easy to embrace MACRA, with all its complexity and questions, it is yet to answer. But, the fact remains that MACRA is absolutely an improvement on the systems now in place. A lot can be done to improve and make it easier for the benefit of all that is involved, but scrapping is not an option at this point. The unprecedented support this legislation enjoys from both side of the aisle is a testament to public support the act receives.
MACRA is certain to create a few hiccups which in any case can be discussed and ironed out. After all, no solution is perfect and results uncertain till testing.