MACRA – 5 Big Questions Answered

MACRA Resource CenterThere has been much discussion surrounding the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Brought to you by the Centers for Medicare & Medicaid Services (CMS), it is designed to fix the previous Medicare payment formula in order to create a sustainable physician payment structure with long-term actionable savings. Recently, Kelly Whittle, of Whittle Advisors answered five MACRA questions that we’ve heard most frequently.

Why MACRA? Why now?
MACRA is part of a broad strategy that is moving the healthcare industry from a fee-for-service to value-based business model. The goal of value-based care is to align patients, payers and providers to achieve better patient outcomes, at a lower cost, for improved population health. MACRA guides us in this transition from the old system, which was not sustainable.

Does MACRA replace MU, PQRS, and VBM?
Individual regulations such as Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the value-based modifier (VBM) have not disappeared. They are now tucked under MACRA, which acts as an umbrella. While MACRA doesn’t replace or rewrite those individual regulations, it strives to simplify and align them.

MACRA does replace the Medicare Sustainable Growth Rate (SGR), a method used by CMS to control spending by Medicare on physician services. The payment formula for the SGR was complicated and was dependent on the national GDP. With MACRA, payments are now calculated on a much more stable playing field, where providers can have more confidence in the consistency of their reimbursements.

Is MACRA in danger if the ACA is repealed?
MACRA and the ACA are two separate pieces of legislation. The ACA, sometimes referred to as Obamacare, is what the current administration is looking at replacing. MACRA is also known as the Quality Payment Program (QPP) and is outside of the ACA. MACRA is not likely to be impacted by action taken to repeal/replace the ACA because:

  • MACRA is not part of the ACA
  • MACRA received bi-partisan support from both houses and parties
  • MACRA is designed as payment reform – fee-for-service to value-based healthcare – and is designed to drive efficiency in the industry

What are the key dates in the MACRA timeline to be aware of?
From January 2017 through 2026 provisions associated with the MACRA regulation go into effect. In this first year, we are concerned with a narrower timeline:

  • January 1, 2017 – Transition year began
  • January 1 to December 31, 2017 – The first year of reporting
  • June 30, 2017 – Deadline for groups of 25+ providers that want to use the CMS GPRO data submission process to register (log into GPRO and identify your providers) – if you don’t use GPRO there are other ways to send in your data and be compliant
  • March 31, 2018 – 2017 data submission must be completed
  • 2019 – Payment adjustment takes place

How can I minimize the strain of MACRA on my practice?
The first step is to understand the impact of this transition. Value-based healthcare is here to stay and will expand over time. Success requires a strategy to identify gaps, mitigate risks, and implement the new value-based business model:

  • Complete a review of current operational and analytic capabilities and understand where your current operation will be impacted.
  • Identify and document gaps.
    • Do you have the ability to do the basics?
    • Can you identify quality-based measures?
    • Can you output the necessary analytics?
  • Create an action plan based on the gap assessment that prioritizes the areas of highest financial benefit and risk.
    • What needs to take place so you can become compliant?
    • What are the action steps?
    • Identify dates for completing the work.
  • Complete some engagement and improvement activities.
  • Have a strong partner with the necessary skills and knowledge to guide you through strategies. This can be one of the keys to ensure you do not assume unnecessary risks and sustain loss.
  • Have the latest technology in your EHR (a certified EHR is required for 2018).
  • Know that if you don’t report anything in 2017 you will receive a 4% penalty.

Quest Diagnostics helps providers connect across the healthcare landscape to improve quality, health, and financial outcomes. The Quanum certified EHR can help you report for MACRA in 2017 and beyond. To learn more about MACRA, join us for our second webinar with Kelly Whittle, Inside MACRA: The MIPS track explained, or call us at 1.888.835.3409.

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