On October 14, CMS released a final rule outlining new payment programs under MACRA. The enormity of the new rules reflect the transformative intent of the law. The transition time given is an acknowledgement that payment reform will be an evolutionary process that will take many years.
But, do not mistake this transition year as similar to past laws or policy changes that have been more about delays and “kicking the can” down the road. The MACRA journey is underway; we are full speed ahead.
MACRA will require strategic choices, clinical and financial transformation, and new investments. Many hospital system executives and clinicians are beginning to understand the transformative and organizational changes needed. For a CEO to transition his or her organization to new risk-bearing models or a CFO to change a revenue mix from volume to value, it may take strategic planning across the enterprise, data, technology, infrastructure, and more. For a clinician to understand – let alone change – new care models, it may require a shift in focus to outcomes over processes, engagement with physician leadership to motivate change, and new performance management programs.
In addition to significant new performance measures, reporting requirements, and compliance exercises, MACRA will necessitate major strategic decisions for physicians and other clinicians in how they organize themselves and how quickly they move into coordinated care arrangements. Similar decisions await health systems and health plans that employ those health care professionals or rely on them for patient referrals and to build their networks. And, while the law directly impacts Medicare payments through the Physician Fee Schedule, it also lays the groundwork and provides strong incentives for other payers to move in the same direction, thus potentially disrupting the health care system at all levels.
Even though transition time is given and clinicians can “pick their path” to ease in, there are several critical issues to consider:
Perhaps it is best to think about MACRA as similar to earning a degree. If you skate by in your first year of classes, then year two becomes that much harder because you have not adequately prepared in your foundational courses. Each year builds upon the last. For the first year of MACRA, the good news is that the teacher has said that while you must participate in class, you can build a foundation at your pace and even receive some extra credit along the way.
Read more about how MACRA is disrupting the health care system at every level.