Winter 2017 Newsletter ♦ Introduction to MACRA

By Larry Ozeran, President, Clinical Informatics, Inc.

Now that the elections are behind us, most of us in healthcare are focused on MACRA (Medicare Access and CHIP Reauthorization Act of 2015). MACRA was how Congress replaced the SGR (Sustainable Growth Rate) after years of unsuccessful legislative alternatives. In the last 20 years, only the 2010 ACA (Affordable Care Act) is likely to have a bigger impact on our healthcare system than MACRA. (If the ACA is repealed . . well, that is a story for another day.)

The Centers for Medicare & Medicaid Services (CMS) released the preliminary rule in April, and received approximately four thousand comments into June. There were many significant concerns raised, and it appears that CMS made a serious effort to mitigate at least some of those concerns within the constraints of the legislation.

Healthcare providers and staff should have no less than a general understanding of how MACRA will impact healthcare for years to come.

The final rule comes to just shy of 2,400 pages, so there is much more to MACRA than can fit in this column. In short, MACRA repealed the Medicare SGR payment formula, consolidated several quality initiatives (including PQRS), renamed MU as the ACI (Advancing Care Initiative) metric and added a practice improvement metric. Managing healthcare costs, originally set to start in 2017, temporarily has zero impact on provider payment. Most notably, those earning bonuses for exceptional metrics are paid from the penalties applied to those with poor metrics. This zero-sum game is postponed for one year with $500 million in new funds. MACRA only impacts provider payments, not hospital payments, and now has an exception for small provider practices with less than $30,000 in annual Medicare billing or fewer than 100 Medicare patients.

CMS acknowledged the extensive nature of the Medicare payment changes by calling 2017 a transition year and offering four ways to participate. They made it very clear they want continued feedback, including on this final rule, and plan to make adjustments through 2018. The payment impact of 2017 activities will not be felt until 2019. The program starts on January 1, 2017. Expect more details in a future newsletter. In the meantime, start your engines…

Fact Sheet: https://qpp.cms.gov/education
Final Rule: https://qpp.cms.gov/docs/CMS-5517-FC.pdf
Final Rule Executive Summary: https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf

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