Even if you’re not directly involved in the healthcare industry and serving patients, you have probably heard and noticed the cost of healthcare going up almost every year. An organization that has been directly affected by this increase is CMS (The Centers for Medicare and Medicaid Services), which paid $1.12 trillion in 2014 for health services. To take control of healthcare costs, CMS and President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 that aims to change the way healthcare payments and treatment happen. Preparing for MACRA means overhauling a system that is enormous and hasn’t seen significant changes in several decades.
One of the most significant changes being required of MACRA is the change from a fee-for-service-based payment system to a fee-for-performance-based model. What this means for healthcare providers is streamlining and carefully choosing how and what patients are subjected to. Originally, a physician might order several tests or treatments due to an internal mandate to make a certain amount of money per month. This not only inconvenienced the patient, but may have proven a waste of time and effort on the part of everyone involved, and then led to no meaningful information at the end of it all.
Now, physicians are being more selective about processes and procedures knowing that their reimbursement for these might not measure up to the costs involved. This doesn’t mean that the patient’s care is being compromised by any means, but that the care the patient is receiving isn’t just having them jump through hoops for the sake of helping a facility meet its quota. Physicians and facilities must prove that the outcome of a patient was bettered by the treatment and care they received.
If you’re wondering why MACRA and the fact that it is Medicare based could have such far-reaching effects on the healthcare system as a whole, well, many private health insurance companies are watching how this new system works in order to follow in its footsteps. Private insurance companies have been looking for a way to reform the system, and have not had enough clout to influence the entirety, but CMS, with its ability to regulate changes and guide payments, does have this ability.
There are two different payment systems which organizations can choose to be a part of. The first, and what is assumed to be the most popular is MIPS (Merit-based Incentive Payment System), which consolidates existing quality improvement and reporting programs and tracks performance and overall costs involved with healthcare. The second system is APM (Advanced Alternative Payment Models), which builds on the foundation of MIPS, and then requires use of certified electronic health record technology, added quality measures and be for financial responsible for meeting specified federal regulations.
No organization should enter lightly into this decision, even though the default program will be MIPS. This kind of drastic measure is the overhaul that CMS is looking to implement and was signed into law in 2015. There is a true need to control the rising costs of healthcare and to provide better healthcare with better outcomes for patients. So, isn’t it better to ride the wave rather than being part of the wake and trying to catch up?
Preparing for MACRA, no matter which program is decided upon, is about knowing what is coming, knowing the requirements, and getting everyone on board. Obviously, it isn’t as simple as just these few items, especially where the government is involved. Many fine details are written into the MACRA program, and there are details that have yet to be defined due to the fact that there are still some unknowns in the program. What is meant by some undefined standards is that not enough information has been collected to make clear measurement standards, and so future information will be revealed.
“The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into
small manageable tasks, and then starting on the first one.” Mark Twain
More definite guidelines and standards will be put forward as healthcare organizations participate in the data gathering and reporting that will start Jan. 1st, 2017 and go throughout the entire year. So, don’t use the fact that everything hasn’t been outlined as an excuse to not get ready, preparing for MACRA should be a high priority. Begin educating yourself and your organization to what is coming, especially by setting goals and deadlines. This will help to make the transition smoother.