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Will MACRA Survive the New Presidential Administration?

Industry analysts and pundits have been evaluating the pros and cons of the Medicare Access & CHIP Reauthorization Act (MACRA) since it was introduced. Two years and a few iterations later, many are still wondering: what is MACRA all about and will it stick around?

At its core, MACRA represents the evolution from fee-for-service payments to value-based care by rewarding physicians driving positive outcomes and providing high-quality, high-value care (need a MACRA refresher? read our CliffNotes version here). Despite the promises of a complete “repeal and replace” of the Affordable Care Act (ACA), MACRA’s bipartisan support will most likely guarantee its continued implementation regardless of the threats to deregulate.

According to HealthData Management, MACRA’s new payment systems “rely on institutions and clinical organization devised to execute value-based care services via ACA programs and rules.” This means, that while there may be alterations to the framework of MACRA, the core of the program, its practices and technology that were prompted by the ACA, will continue in much the same way. There is a provision allowing for yearly review by the administration, and with Tom Price’s confirmation as Health and Human Services Secretary, he could make alterations to the rules.

It’s well documented that one of Price’s missions is to lessen regulatory burdens on physicians which could lead to slower implementation, or dilution of certain value-based components, such as reporting requirements and reforms. However, it’s difficult to imagine a lack of support from Price and the Trump administration for shared-savings programs and bundled payments, such as Accountable Care Organizations (ACOs), especially as ACOs continue to prove their value as an alternative to fee-for-service payments and an increasing number of providers move to this model.

MACRA’s implications will be far-reaching ­– here are four takeaways to help organizations across the industry capitalize on the opportunities ahead:

  • For health systems and hospitals, the time to act is now. With Medicare adjustments jumping from four percent to 18 percent in just four years, and payments to providers delayed by two years, you cannot afford to fall behind, or risk huge rate adjustments for any mistakes made in reporting data. If your health system has already initiated the process, stay the course of transitioning your current reporting models for government payers to align with value-based performance to excel under MACRA.
  • MACRA’s new payment models will “increasingly influence care patterns in favor of treatments that improve downstream clinical, financial, and patient-reported outcomes,” according to PolicyMed. Providers are incentivized to coordinate care across different settings, forcing stronger relationships and information sharing with skilled nursing, home health, and long-term care services.
  • Whether providers opt for the APM or MIPS tracks, the reporting and quality requirements are significant. The winners in health IT will accomplish three key things: the ability to streamline and coordinate high-value care; seamless and easy reporting based on that organization’s selected path; and a cost-neutral model backed by a history of clear results.
  • Health plans are likely to seek more risk-sharing arrangements with healthcare providers under MACRA’s provisions. Negotiations could be more difficult for health plans with less negotiating leverage in the marketplace, if providers are not interested in this type of agreement. Conversely, health plans with a more stable negotiating position, and providers that share the plan’s interest in risk-sharing, can benefit from this arrangement by forging new contracts that include this measure.

No matter what deregulation threats are made in the future, it’s critical for every industry partner to continue to implement systems to keep up with MACRA’s reporting. The potential risk for all affected parties is too great to fall behind. According to Health Catalyst and Peer60 research “those (health systems) marching ahead are finding that compliance is likely to benefit their organization. The bottom line is that systems can choose which measures to report from their 2017 data, even if they haven’t finalized their MACRA compliance plan, and it’s likely worth their time.” MACRA, in some form, is here to stay.

April 11, 2018
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