The MACRA (Medicare Access and CHIP Reauthorization Act) legislation is upon us and regardless of whether you love or hate government regulation of healthcare, MACRA is here to stay and is going to impact small practices in a big way. While Meaningful Use caused a pandemonium around EHR adoption, MACRA is going to have a much bigger long-term impact on the healthcare business as we know it.
For those not familiar with the MACRA legislation it's broken down into two quality programs: MIPS (Merit-based Incentive Payment System) and APMs (Alternative Payment Models). The MIPS program rolls up PQRS, the Value-Based Modifier, and Meaningful Use (Medicare EHR Incentive Program) into one streamlined program. Plus, it adds a new program called Clinical Practice Improvement Activities (CPIA). The APM program rolls together a number of value-based healthcare programs including ACOs (Accountable Care Organizations) and PCMH (Patient Centered Medical Homes).
The MACRA legislation is the backbone of the efforts CMS is making to move healthcare to a value-based healthcare system. CMS has stated their goal is to have 30% of Medicare payment tied to quality or value through alternative payment models by the end of 2016 (already achieved) and 50% by the end of 2018. MACRA is the legislation they will use to reach this goal.
If you're in a small practice and thinking this will pass, you are likely in for a rude awakening.
Not only will MACRA not just "pass", but it will serve as the foundation for future value-based reimbursement efforts that CMS employs. Yes, this is just the start of the movement towards doctors spending time keeping patients healthy as opposed to doctors time being spent treating the chief complaint.
Plus, we're likely to see other commercial payers follow suit soon. Each of them has stated similar goals to CMS. In fact, many payers are watching the MACRA legislation to know which elements they should consider implementing. Plus, CMS is even looking at ways to reward providers who are taking part in value-based programs from commercial insurers.
Once you break down the MACRA legislation, you'll see that CMS has made real attempts to simplify and consolidate the previous legislation. One of the best examples of this was their decision to do away with the "all or nothing" feature of the previous programs. The MACRA program rewards organizations for their efforts even if they don't comply 100% with every requirement. This is a big change that will make a lot of organizations very happy.
The other thing small practices should know about MACRA is that if they've been participating in PQRS, Meaningful Use, and the Value-Based Modifier, then MACRA will not be a huge leap to achieve. There will be some hoop jumping (welcome to government), but it won't be that much harder than what you're already doing.
The exciting thing about the movement to value-based care is that it's the way most doctors really want to practice medicine. Most doctors I know would love to get off the fee-for-service treadmill. They dream of being able to spend time with patients really focused on their health. There will no doubt be a lot of bumps in the road on this journey, but MACRA is going to be CMS's first step down that road.