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Why Value-Based Care Reimbursement, MACRA are Here to Stay

Regardless of which political party is in Congress, the healthcare industry is steadily moving forward with value-based care reimbursement.

By Vera Gruessner

The outcome of the presidential election has led to some uncertainty throughout the healthcare industry when it comes to legislative changes and medical coverage. However, providers and payers will need to keep a clear head in the coming months and remember which legislative achievements and healthcare reforms will likely be here to stay for years to come. For instance, the overall trajectory of the healthcare industry has been moving toward value-based care reimbursement in order to cut rising medical spending.

Quality Payment Program

One example of a major piece of legislation that is likely to remain is MACRA and its Quality Payment Program. With the Centers for Medicare & Medicaid Services (CMS) determined to transition to value-based care reimbursement, MACRA legislation has received bipartisan support and is likely here to stay. Hospitals and other medical facilities are unlikely to experience any uncertainty revolving around revenue due to MACRA legislative changes.

The New York Times outlined how the move to value-based care reimbursement is a bipartisan factor in healthcare payment reform and the Republican Congress has been supportive of innovating provider reimbursement and methods for reducing medical spending.

“Those are bipartisan issues,” Karen Ignagni, the Chief Executive of the health plan EmblemHealth, told the news source.

Nonetheless, certain critics have claimed that the speed with which the federal government will move forward in value-based care reimbursement may decline under the new President Elect.  Chas Roades, the Chief Research Officer for the Advisory Board Company, claims that the Republican Congress will be less concerned with reforming the way payments are made and focus more on reducing the actual cost the federal government puts toward provider reimbursement.

READ MORE: Payers Benefit from Aligning with MIPS, Value-Based Care

“I think it is the end of payment reform, but the beginning of payment cuts,” Roades said.

Nonetheless, others claim that the healthcare industry as a whole is moving away from the fee-for-service payment system and embracing value-based care reimbursement in an effort to improve the quality of care while reducing cost. Dr. David T. Feinberg, the chief executive of Geisinger Health System, told The New York Times that “the market ... is not going to go back.”

John Nicolaou, Managing Consultant at PA Consulting Group, provided some background to on the future of MACRA legislation and how parts of the Affordable Care Act are also likely to remain in place during the new administration in the White House.

“Any changes to MACRA are unlikely,” Nicolaou said.

The movement toward value-based care reimbursement especially MACRA regulations and its Quality Payment Program are unlikely to see any major changes, Nicolaou  explained. Private payers have been steadily moving in the direction of the value-based care environment. For example, Humana recently announced that it is serving 63 percent of its membership through value-based care reimbursement contracts.

READ MORE: Communication Key for Transition to Alternative Payment Models

Since MACRA regulations are supported by both political parties, the legislation is unlikely to be repealed, Forbes reported. Nilesh Chandra of PA Consulting told the news source that “MACRA is here to stay” because of its bipartisanship and providers will likely not face any uncertainties regarding reimbursement under MACRA legislation.  

Andy Slavitt, CMS Acting Administrator, also backed up the idea that the federal agency will stick to improving patient care through alternative payment models whether the White House and Congress is controlled by Democratic or Republican parties.

“It’s a certainty that making our delivery system work better for patients and spend money more wisely will always be in season no matter which party is in charge. And, while many new approaches and changes may come to bear, ultimately health is not a partisan issue,” Slavitt said at the MACRA MIPS/APM Summit last week.

Last week, the American Hospital Association (AHA) sent a letter to the Trump administration recommending them to support the transition to value-based care reimbursement and alternative payment models while also promoting telehealth. AHA urged the administration to put an end to barriers for telehealth and remote patient monitoring.

Along with the strive for alternative payment models, MACRA legislation may also push forward value-based care reimbursement even further, said Beckie Croes, Senior Vice President of Provider Engagement at Care Allies, last month.

READ MORE: Quality Metrics Pose Problems for Value-Based Care Reimbursement

“Payers are impacted in two distinct ways,” Croes noted. “One of those would be a halo effect. 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.”


Dig Deeper:

How Medicare, Medicaid, and CHIP Guide the Health Payer Industry

Key Steps for Payer Success in Accountable Care Organizations


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