MACRA Plans in Healthcare

by MACRA Plans on

It’s slightly over two years since the Congress passed the Medicare Access and Chip Reauthorization Act of 2015, MACRA. The goal of the federal legislation is to evaluate and reimburse physicians based on value rather than volume in patient care in the United States. In this post, you’ll learn all about MACRA, the changes it’s brought to the healthcare and the benefits to the clinicians and health providers.

MACRA plans affected the Medicare Payment to Providers in 3 ways:

  • The act annulled the Sustainable Growth Rate (SGR) formula used in determining the Medicare reimbursement rates for the services offered by physicians.
  • Under MACRA legislation, all the existing payment programs cease to exist.
  • Payments to the participants will be based on how quality and effective the services they offer patients are and not the current fee-for-service program.

MACRA quality and value-based healthcare payment encompasses three reimbursement structures:

1. Merit-Based Incentive Payments System (MIPS) – this put three former programs, PQRS, VM, and EHR together. MIPS now requires the Eligible Professionals (EPs) be evaluated and paid based on

  • Quality of service
  • Resource use
  • Clinical Practice Improvement
  • Meaningful use of EHR Technology

2. Alternative Payment Methods (APMs) – under the new program, this becomes method through which the Medicare will compensate the healthcare providers for beneficiaries of Medicare. Although the providers who participate in APMs will be subjected to MIPS, they should expect payments rates under this new program. Also, any provider who takes part in most APMs such as ACOs stands a chance to be granted Qualifying APM Participants (QPs). That qualifies you as a provider to be excluded from MIPS. Additionally, the provider will be eligible for;

  • 5% lump-sum bonus payment per year from 2019 to 2024
  • Higher fee schedule updates from 2026
  • Flexible physician-oriented payment models

3. Advanced Alternative Payment Models- eligible APMs for advanced MIPS structure stand a chance of getting even higher reimbursements although performance is still key. The provider eligible for APMs is required to make better use certified electronic health record (EHR) technology.

Why Is MACRA Important to You as a Healthcare Provider and Physicians?

You’ll agree that the MACRA plan is overly complicated. In fact, in our delivery, we’ve just provided a sneak-peak into how the whole thing works. Besides, another flaw is the fast implementation and the unfavorable nature to the small physician practices. Discussed below are the benefits of MACRA.

MACRA voids the flawed and unfavorable Sustainable Growth Rate (SGR) formula– SGR was a law passed by the Congress in the year 1997 to stem the rising cost of Medicare although it never worked. That made access to Medicare a highly disorganized affair with most doctors opting out of the Medicare program to avoid the pay cut meant to cater for the SGA program.

The new legislation led to the scrapping off of the 21% pay cut for the services provided to Medicare beneficiaries. As such, doctors are now willing to offer their services to Medicare patients.

Also, with MACRA now funds Children Health Insurance Program (CHIP), a program aimed at covering children from low and middle-income families but whose income is too high to qualify for Medicaid.

MACRA rewards value and quality, not volume- the new program scraps the fee-for-serve and adopts reimbursements for the quality of services rendered. If a doctor agrees chooses to participate in the Accountable Care Organization (ACO) or MIPS, he/she will be committed to patient’s care.

Also, if a provider participates in APMs, they stand a chance to enjoy a couple of benefits as already discussed.  Performance-based compensation is a sure way of boosting the performance of the physicians. Ultimately, the entire industry benefits.

It offers MIPS Advancing Care Information– MACRA stresses on the meaningful use of EHR Technology. As such, a safe database with all the patients’ details including the health history will have to be maintained with the goal of encouraging the exchange of health information and patient engagement. Physicians and providers can access all the info regarding a patient from different facilities.

Although the change may feel overwhelming, MACRA is here to revolutionize the healthcare industry. HealthCatalyst offers you reliable MACRA solutions that will you ahead of others.  Patients, doctors as well as providers stand to benefit from the program, and that’s why everyone needs to embrace it.