MACRA: Disrupting the Healthcare System at Every Level

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is poised to drive health care delivery and payment reform across clinicians, health systems, Medicare, and other government and commercial payers.

On May 9, 2016, the US Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would implement key features of this law: the Merit-based Incentive Payment System (MIPS), which would apply to eligible clinicians that Medicare pays under the Physician Fee Schedule (PFS), as well as the incentives for clinicians to participate in Advanced Alternative Payment Models (APMs).

The proposed rule's release gives stakeholders more information to assist in planning their MACRA strategies. Among questions facing clinicians and health systems:

• Which payment track will be the best fit for our practice/organization now? In five years? In 10 years?
• If organizations opt for MIPS: Do we have the people, processes, and technology in place to accurately collect and report data on the MIPS measures? How can we help clinicians perform well on these measures in order to receive positive payment updates?
• If organizations choose to invest in APMs: Given our current payer mix, is it possible for professionals to meet the revenue or patient-count thresholds required to qualify for APM incentive payments and higher payment updates? Are we experienced with and successful at managing risk under these Advanced APMs? What types of Advanced APM arrangements will be most beneficial for us?

The timeline for stakeholders to prepare for MACRA reporting and compliance is short and there is much to do. Read more in MACRA: Disrupting the health care system at every level.