January 17th, 2018
MACRA, orthe Medicare Access and CHIP Reauthorization Act of 2015, revised the way physicians are paid when caring for Medicare beneficiaries. MACRA replaced the previous Medicare reimbursement schedule with a pay-for-performance program focused on quality, value, and accountability. Just as you should understand your medical business insurance, understanding how MACRA and your private practice interact is key to your success.
In a nutshell, MACRA instituted measures designed to increase accountability and provide incentives to improve care while restraining cost growth. The goal is to promote efficient, effective, and safe healthcare—while discouraging excessive and unnecessary treatments. Reports of inappropriate and excessive care have become common, even as rising healthcare costs burden government, business, and families. Under MACRA, a healthcare provider's performance results are made available to Medicare beneficiaries and consumers. The goal is to help patients choose the most effective individual physicians and physician groups.
Moving From Volume to Value
Federal law has long discouraged dictating the way doctors cared for patients. However, with abuses of the Medicare system coming to light, a rising chorus of voices demanded more government oversight. The intent of MACRA is to reward physicians who provide superior care, while penalizing those who do not. However, this begs the question of how to accurately quantify the value of care a single physician provides. Under MACRA, physician pay is based on success in four performance categories. These are quality, resource use, clinical practice improvement, and advancing care information through use of health information technology. The Physician Compare website was established to give patients a way to see how individual doctors stack up in these areas.
MACRA And Small Practices
While there are two systems by which MACRA proposes to reward physician effectiveness, most small practices will fall into tone of the Alternative Payment Models. The biggest concern for most practitioners in this category is the mandating of a certified electronic health record (EHR) technology. Given EHRs have become the norm rather than the exception in modern medical practice, this is a reasonable requirement. Further, MACRA provides $20 million annually to help small practices transition into the system. Additionally, physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year are exempt. What's more, the impact on smaller practitioners is expected to be negligible, as large practices care for the bulk of Medicare beneficiaries.
The Paradigm Has Shifted
While there are bound to be tweaks and adjustments along the way, MACRA is the new reality for the foreseeable future. Full implementation begins in 2018. Change always comes with a bit of inconvenience and this is as true here as it is anywhere else. To help smaller private practices deal with it, the CMS allows partnering among doctors for the purposes of compliance. Another way to mitigate costs is to find ways to reduce your overall expenses. CoverHound can help you find the best medical business insurance possible, at affordable rates. Try it today! You'll be glad you did.