Five Things You Should Know About MACRA

October 21, 2016 Bryan Smith

MACRA, MIPS, APMs, QPP…it certainly can be an alphabet soup! You have probably heard some of these acronyms before, but do you know what they mean for the future of healthcare? We can break it down for you. Below are five key things to know about the MACRA ruling announced last week and the impact it will have on the healthcare industry. 

1. It creates two new Medicare payment models for physicians.

The Centers for Medicare & Medicaid Services (CMS) Medicare Access & CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP) has two new payment tracks that physicians can follow to achieve reimbursement.

The Merit-Based Incentive Payment System (MIPS) combines parts of three outdated quality reporting initiatives into one single incentive program. Those eligible are evaluated on quality, cost (starting 2018), improvement activities and using certified EHR technology to enhance care (formerly meaningful use).

Advanced Alternative Payment Models (APMs) are a second reimbursement option, offering new ways to reward eligible providers for care they give to Medicare beneficiaries. Certain Accountable Care Organizations (ACOs), Patient Centered Medical Homes and bundled payment models are examples of these alternative options.

 2. It drives physician alignment.

MACRA shifts risk to physician practices. To increase the likelihood of success in MIPS or Advanced APMs, physician practices are aligning together and with health systems to improve performance. Regardless of the model they choose, physicians will need to report and improve quality and reduce costs. Both payment pathways develop a push-pull dynamic, driving providers toward implementing integrated population health management models across the continuum through aligned value-based incentives.

3. It has strategic and economic impacts.

MACRA has strategic and economic impacts for physicians, hospitals and health systems, ultimately accelerating the transition to value-based care and alternative payment structures. With challenge comes great potential, as many providers are identifying new opportunities to redesign their care approach, and expand clinical integration capabilities to optimize financial reimbursements. To do so, there will be an increasing emphasis on the allocation of resources; however, many independent physicians and small medical groups do not have the resources needed to meet MACRA performance measuring and data reporting requirements.

4. Clinical integration is an added benefit.

Whether you’re a hospital patient, a physician with your own practice or leading a major health system, you will benefit from clinical integration. MACRA continues the trend toward the creation of Clinically Integrated Networks (CINs), or partnerships between physicians and health systems that are committed to improving the quality and efficiency of care delivered to their patient populations. These networks drive improved performance and alignment, making them an attractive option to healthcare leaders. Smaller practices with limited resources may recognize new clinical integration opportunities as a way of meeting MACRA mandates.

5. It promotes cost and quality transparency.

Ultimately, MACRA drives increased transparency on the quality and cost of care, placing clinicians at risk and helping lead the way toward a value-based, wellness-focused future. Over time, these new options increase both financial risks and potential rewards for clinicians, while ensuring for patients that the “status quo” is no longer an option.

Are you struggling on the journey to providing patient-centered, value-based care? Looking for help creating a MACRA roadmap to support Quality Payment Program transformation?

Join us for our next Advisor Live® on Nov. 2, 2016: Understanding the MACRA Quality Payment Program and What You Can Do to Prepare.

Author information

Bryan Smith

Bryan Smith

Principal, Premier Performance Partner at Premier, Inc.

I’m a consultant who helps physicians and health systems achieve greater operational, financial and strategic alignment. When I’m not working you’ll find me with my wife looking for the best restaurants in the Dallas/Fort Worth area or scouring the local bookstores. Connect with me on LinkedIn.

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