How MACRA Affects Future of Healthcare Payment Models
By - Earlier this year, the federal government repealed the Medicare Sustainable Growth Rate (SGR) Formula, which affected the future of healthcare payment models all across the board. Recently, the Centers for Medicare & Medicaid Services (CMS) extended the deadline for the comment period of the Request for Information under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Originally, the comment period was due to end on November 2, 2015 but was extended a few weeks to continue until November 17, 2015. The Request for Information is specifically seeking public comments on section 101 of the MACRA legislation. The comment period is expected to make an impact on the overall rulemaking associated with the legislation.
Section 101 of this particular legislative action repeals the SGR formula when it comes to updating the Physician Fee Schedule and a larger update rate for those participating in alternative healthcare payment models.
Some other updates worthy to note under Section 101 include the Merit-based Incentive Payment System (MIPS) for eligible professionals, the Value-Based Payment Modifier (VM), payment adjustments related to the Physician Quality Reporting System (PQRS), and the Medicare Electronic Health Record (EHR) Incentive Program.
Eligible professionals who take part in alternative healthcare payment models and foster the development of physician-focused payment models could receive payment incentives from CMS under Section 101 of the new legislation. The public can submit comments to the Request for Information of MACRA until November 17.
Comments can be submitted electronically through the Federal Register website. Additionally, the public can send in comments by regular mail, express mail, or courier. More information about the legislation can be found by viewing the full text of the Medicare Access and CHIP Reauthorization Act of 2015.
Healthcare payment models seem to be changing across the medical industry, as more providers and payers are immersing themselves in value-based care and moving away from fee-for-service payment systems due to new healthcare reform legislative actions.
For instance, the Harvard Business Review reported on the increased use of bundled payment systems throughout the industry. Bundled payments are essentially one general fee that covers all of a patient’s treatments and services for a given medical condition in a specified timeframe.
The Bundled Payments for Care Improvement program specifically helps Medicare patients by developing new payment model structures between commercial insurers and medical providers.
“Building on the BPCI program, the Centers for Medicare and Medicaid Services (CMS) in July 2015 announced a proposal called the Comprehensive Care for Joint Replacements (CCJR) program to mandate the use of bundled payments for knee and hip replacements in 75 metropolitan areas beginning in 2016. Under the proposed rules, hospitals would be financially accountable for not only the cost of the surgery and subsequent hospital stay but also the payments to the physician performing the surgery and all subsequent medical costs in the 90 days after discharge,” the Harvard Business Review stated.
These types of payment models also stimulate the adoption of healthcare analytics and the inclusion of more data regarding patients’ health outcomes, hospital readmission rates, infection rates, lengths of stay, and other potential barriers.
This past summer, the National Partnership for Women & Families (NPWF) endorsed some of the initiatives taken by CMS to create patient-centered bundled payment models, according to RevCycleIntelligence.com. Essentially, the spokespeople for this organization find that bundled payment models offer better care coordination and more cost containment across the healthcare industry.
“As alternative payment models like the Comprehensive Care for Joint Replacement roll out, we will continue to educate consumers about the potential benefits, and help patients and families understand and engage effectively in their care,” Debra Ness, NPWF President, said in a public statement.
“But it is essential that Congress continue funding CMS to develop and test these new models of payment, so that we can continue moving toward a health care system that is truly patient- and family-centered.”
