It may be surprising, but many physicians are not familiar with the Medicare Access and CHIP Reauthorization act of 2015 (MACRA), or at least its name. It was established as a new
way to pay doctors who treat patients covered by Medicare. MACRA was intended by Congress to enable the health care system to have a new and faster way of servicing Americans. This summary is meant to offer a closer look at this game-changer and how it affects all professionals in the health care industry.
What Is MACRA?
The Medicare Access and CHIP Reauthorization Act of 2015 was created to swiftly drive the health care delivery and payment reform. It applies to clinicians, health systems and Medicare.
Last year, the U.S. Centers for Medicare and Medicaid Services (CMS) officially implemented a rule that was quite a game-changer for many practices.
There is a merit-based incentive payment system, otherwise known as MIPS, applying to physicians who are paid by Medicare under the Physician Fee Schedule.
In light of MACRA, many clinicians and decision makers in the health system may find themselves asking the following questions:
- How do I know which track payment is the best fit for our company, even 10 years from now?
- Is the right technology that is needed for collecting and reporting MIPS measure data in place?
- How do we enable clinicians to have outstanding performances, necessary for them to avail of the payment updates?
The MACRA Law and What It Means for Physicians
These are some of the vital questions that professionals need to ask, because significant revenue is at stake for many practices and clinics that are paid through the Medicare PFS. The intent of MACRA is to reduce health care spending by rewarding those clinicians based on performance in four areas: quality, cost, improvement activities and advancing care information. Therefore, the question that most clinicians want an answer to is: Are the physicians ready for this? The enormous changes and development in practice need to be addressed.
The Deloitte Center Survey
The Deloitte Center for Health Solutions 2016 survey of U.S. physicians was able to shed light on these matters.
Deloitte conducted a thorough survey of 600 primary care and specialty physicians, who answered questions on a number of topics, from payment models to health IT.
An analysis of the survey results showed that many physicians had never even heard about MACRA. Upon hearing about it, many realized that in order to succeed under it, they would have to make significant changes to their practice. This would require access to sufficient resources and support, and would also mean exposure to the threat of increased financial risk.
The main findings of this survey in more detail are the following:
- Fifty percent of the respondents said this was the first time they had heard about MACRA.
- Thirty-two percent had heard about its name, but were unsure of how it works or what the requirements are.
- Twenty-one percent, who were mostly the self-employed physicians, were the group most familiar with MACRA. Those employed by government and hospitals or health systems who knew of the law were just 9 percent of the professionals surveyed.
- Eighty percent answered that they preferred traditional fee-for-service (FFS) or salary-based compensation, and not the value-based payment models, which are required under MACRA.
- Meanwhile, 74 percent of the physicians surveyed admitted that reporting regularly on their performance was burdensome, making them opposed to the idea of compensation based on quality.
- Fifty-eight percent of the physicians said they would opt to be part of a larger organization, but were aware of the individual increased financial risk, so they would require access to supporting resources and capabilities.
More about the Findings of the Survey
The full outline of CMS detailing the new payment programs under MACRA came to almost 2,400 pages. It was a massive undertaking but also a lot to read and digest for even the most knowledgeable in the field of health policy.
Is a New Rule of This Size Appropriate?
Because it is the first performance year of the MACRA, its enormity is necessary and, in fact, entirely appropriate. These new rules reflect the law’s full intent, and a practice is given adequate time to change and upgrade, reflecting value and top performance across the board. The industry shift is not something to be expected to happen in an instant.
MACRA Is Disruptive by Design
It is important to note that MACRA is disruptive by design. It was put in place by Congress intentionally so that health care would be cost-effective and outcome-based. It is expected to be an evolutionary process that will gain momentum and success only through trial and error. But all health care professionals can see the potential of the MACRA journey.
The professionals in the health care industry must view MACRA as what it was designed to be: an opportunity to get optimal value from health care. Of course, as the results of the Deloitte study survey show, there will be significant changes that everyone in the industry must be aware of and ready to accommodate.
For the full findings of the MACRA notes and survey, please download the report.
Contact Goldin Peiser & Peiser if you have any questions regarding MACRA or would like information on how to improve the financial health of your practice.
Note: This content is accurate as of the date published above and is subject to change. Please seek professional advice before acting on any matter contained in this article.