How MACRA is Changing the World of Healthcare & How to Prepare
Signed into law on April 16, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) replaces the Sustainable Growth Rate (SGR) with a pay-for-performance approach that promotes value, quality, and accountability. According to the Centers for Medicare and Medicaid Services (CMS), MACRA’s new payment framework is designed to reward value-based care. This simply means that providers will no longer be reimbursed for the services they provide, but for the outcome that results from that service.
MACRA Reimbursement Systems: MIPS and APM
Under MACRA, healthcare providers must decide between the following two options for Medicare reimbursement:
The Merit-Based Incentive Payment System (MIPS)
According to MIPS guidelines, Eligible Professionals (EPs) will be reimbursed considering the following performance metrics:
- Clinical practice improvement
- Meaningful use of certified EHR technology
- Quality of care
- Resources used
Medicare Part B Payment will be adjusted positively, negatively or not at all, depending on how they score in these four areas.
The Alternative Payment Model (APM) Program
An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Those who participate in the most advanced APMS may be classified as Qualifying APM Participants (QPs). A few examples of these types of APMs are:
- Accountable care organizations (ACOs)
- Bundled payment models
- Patient-centered medical homes
Use the Right Technology to Succeed Under MACRA
To comply with these changes, healthcare providers will need to leverage technology to deliver healthcare efficiently and effectively. Physicians will have increased access to alternative, cost-effective delivery channels, making it easier to prepare, treat and follow-up with patients. Traditional high-cost in-home visits from case managers will soon be obsolete.
MACRA will incentivize providers to improve patient care by increasing or decreasing their reimbursements received for services provided. There are many approaches to outcome-based care — addressing quality, post-discharge adherence, patient experience and more — but moving forward, all will require the necessary platform and patient data to be successful.
Care coordination programs are a simple solution to a complex problem. A successful care coordination program will leverage technology and data to create a holistic view of a patient’s health. Clinical professionals or digital case managers can use this data to coach patients toward better outcomes — helping them comply with physician’s instructions or be proactive about their health rather than waiting to treat an injury or illness.
With the right technology, providers will be able to improve patient care through data-driven insights and ongoing communication, resulting in improved outcomes, healthier patients, and maximum reimbursements.
Change is certain and it’s important to be prepared. Take steps to optimize your current patient-communication channels and start considering what new tools you can adopt to ensure success in this new environment.
I’d like to learn more about how your organization is preparing for MACRA, and share some of the risk-management programs we’ve helped our partners put in place.
Daniel Kriger
+1 267-939-7252
Daniel.Kriger@acquirebpo.com