- MACRA regulations have impacted the revenue cycle of providers across the country particularly regarding Medicare reimbursement from the Centers for Medicare & Medicaid Services (CMS). The American Academy of Family Physicians outlined how MACRA impacts Medicare reimbursement by removing the flawed sustainable growth rate (SGR) formula while creating the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
MACRA requirements have consolidated three programs under one system in MIPS, which include the Physician Quality Reporting System, the Value-based Payment Modifier, and meaningful use requirements. CMS also added new performance measures for providers under MIPS called clinical practice improvement activities.
Providers looking to qualify for an Alternative Payment Model need to incorporate a healthcare reimbursement structure part of the Center for Medicare & Medicaid Innovation (CMMI) programs or operate a Medicare Shared Savings Program (MSSP) accountable care organization (ACO), Medicare Health Care Quality Demonstration Program, Medicare Acute Care Episode Demonstration Program, or another federal demonstration program. Healthcare organizations operating under an APM must use quality measures similar to MIPS along with certified electronic health records, according to the American Academy of Family Physicians.
Healthcare payers could improve claims management and streamline the healthcare revenue cycle by aligning their quality programs and value-based care payment structures around MACRA regulations and MIPS requirements. Payers pursuing value-based care reimbursement that aligns with alternative payment models and structures of MACRA are likely to help reduce the administrative burden put on physician practices and hospitals in meeting differing demands of public and private insurers.
MACRA regulations may play a role in advancing value-based care reimbursement between commercial payers, providers, and government agencies. Since MACRA implementation will require providers to more quickly move into value-based care reimbursement arrangements, commercial payers are likely to see more medical facilities willing to partner through a value-based care payment contract.
“As providers are developing their MACRA strategy and their value-based care strategy, that would be around improvement in clinical workflows, improvement in how they address their patients as a population, and they are going to have to determine from a physician engagement perspective, what that construct will look like. That is going to spill over into other lines of business even outside of Medicare fee-for-service,” Beckie Croes, Senior Vice President of Provider Engagement at CareAllies, told HealthPayerIntelligence.com in November.
“Providers that had been hesitant to join value-based care arrangements with payers may be more likely to join and participate in those relationships since they’re going to be forced to make those changes in their workflow to support their Medicare patients.”
However, public and private payers may need to continue working with small medical practices and clinicians to improve training and preparation around MACRA regulations and value-based care requirements. One survey from the Advisory Board shows that 70 percent of 30 surveyed medical groups stated being “concerned” about MACRA regulations.
The survey respondents stated that the requirements are excessively complex, which could increase the likelihood of noncompliance. The survey shows that 20 percent of respondents report being confident about meeting MACRA regulations. Additionally, 50 percent expect to be prepared to report data for all 12 months of 2017. MACRA requirements do allow providers to report for a decreased number of days to receive a lower positive payment adjustment.
Among the rest of respondents, 21 percent stated choosing the partial-year reporting period while 29 percent will only be testing the program to avoid a negative payment adjustment but disqualify from a positive reimbursement incentive.
Last year, Black Book released a May 2016 survey showing that 67 percent of physician groups of five or less doctors and high volumes of Medicare beneficiaries expect to close down their practices due to MIPS and MACRA requirements. As many as 89 percent of respondents out of 1,300 physician groups will be decreasing their Medicare patient volumes to minimize the impact of MACRA.
“Physician payment based on 2017 performance isn’t scheduled to kick in until 2019,” Doug Brown, Managing Partner of Black Book, said in a public statement. “That’s far too long to maintain operations for the most stressed practices to hold on with outmoded technology and scarce billing support.”
With 70 percent of polled medical groups concerned about MACRA regulations and 89 percent of small medical practices looking to decrease their Medicare load, private payers interested in pursuing value-based care payment arrangements and more complex reimbursement structures such as bundled payments or accountable care organizations may need to provide more support to their provider network regarding training and preparation for quality improvement programs.
Nonetheless, the future for commercial payers and providers should be headed in the direction of value-based care reimbursement aligning with MACRA’s Alternative Payment Models.