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Mapping out MACRA (Part One)

Eric Keeney

Welcome to the first post in a four-part series on MACRA–the behemoth piece of legislation that was enacted in 2015 and went into effect on January 1st of this year. MACRA stands for The Medicare Access and CHIP Reauthorization Act and for many healthcare providers, is proving to be a complex problem without an easy solution. We’re kicking things off with some basic background on the legislation itself and what it means for your practice. So, let’s dive in!

THE CAUSE
As is often true of disease itself, MACRA didn’t just fall out of the clear blue sky with no rhyme or reason. Health care costs have been spiraling out of control for decades. Since 1960, U.S. health care spending has increased from 5% of GDP to 17.8% in 2015. In dollars, that’s an annual difference of $9,984 per person. Compounding the issue, quality of care and general population health have not kept pace with rising expenditures and, much like the causes, responses to the problem have varied.

THE EFFECT
MACRA, the latest attempt to address the trio of issues at the heart of the healthcare challenge, arrived in 2015 and was a bi-partisan effort signed into law by President Barack Obama. MACRA changes the game significantly for healthcare providers by shifting from a fee-for-service reimbursement model to a value-based system—incentivizing quality of care, rather than quantity.

MACRA, in all its 800+ page glory, went into effect on January 1st of this year and will begin impacting the real-world revenue of providers in 2019. Reimbursement at that time will consider a variety of factors, including patient outcomes and cost control measures, and is based on 2017 performance.

THE BOTTOM LINE
With the clock already ticking, providers need to act now to develop a solid understanding of the requirements and full implications of MACRA, assess their current data and measurement capabilities and build a comprehensive strategy for managing Medicare billing costs proactively.

In our next installment we will dive into the two basic options for MACRA participation: the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models (APM) and how you can begin to wrap your head around which one might be the best fit for your practice. Check back here in about two weeks or cut to the chase and get the full story right now.