Are you among the 50 percent of doctors that don't know about this important health care system change?

Friday, January 13th, 2017

Healthcare providers have a lot to juggle on the job - from delivering care and measuring quality to staying on top of code changes and remaining knowledgeable about the latest reimbursement updates. According to a recent Deloitte survey, the latter of those duties has fallen on the back burner. Approximately 50 percent of doctors reported they have not yet heard of the payment reform Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Are you among the uninformed? Find out why it matters:

"50% of doctors reported they have not yet heard of MACRA."

What is MACRA and why is it important?
In 2015, the U.S. Department of Health and Human Services set goals for tying fee-for-service payments to value. Specifically, 30 percent of Medicare payments in alternative payment models (APMS) must be linked to quality by the end of this year, and 50 percent must take that same course by the end of 2018. Whether or not physicians meet these goals will influence the amount of their reimbursement. By this standard, physicians who want to earn a sufficient income must do what they can to improve quality of care.

According to the Centers for Medicare and Medicaid Service (CMS), MACRA is an important steppingĀ stone in the switch to value-based care. Not only does this legislation repeal the long-used Sustainable Growth Rate formula for physician reimbursement and Medicare cost containment, it also gives clinicians two options for linking payments to value:

  • Merit-Based Incentive Payment System (MIPS): According to CMS, MIPS measures physicians on quality, resource use, clinical practice improvement and meaningful use of electronic health records.
  • Alternative Payment Models (APMs): Examples of APMs include Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). By using these models, providers receive lump-sum payment incentives.

Considering the first reporting period for this legislation begins in 2017, it seems an integral move for doctors to familiarize themselves with the law as soon as possible.

Getting acquainted with MACRA
Health Catalysts recommended healthcare systems map out a MACRA strategy by the fourth quarter of 2016, which means the 50 percent of physicians who haven't heard of this legislation need to start now.

For one, physicians need to develop a thorough understanding of the law and how it will impact their practice, which can be done by reviewing resources. CMS provides plenty of webinars, and professional healthcare organizations like the American Medical Association offer step-by-step strategies.

Clinicians should also review past quality measures to understand their facilities' strengths and identify areas for improvement. This will allow them to make adjustments as necessary to receive the highest reimbursement possible.

IMO clinical terminology is the most widely used in the industry - find out why.