Contrary to the opinion of some, almost everyone knows that the healthcare system in this country is incredibly complex. Over the past few years, the system has only gotten more complex and bureaucratic, not less. While legislation such as the ACA, or the Affordable Healthcare Act, has improved the ability of millions of people to access healthcare, it also makes healthcare more complicated. On top of that, the federal government recently passed MACRA, also known as the Medicare Access and CHIP Reauthorization Act. While this is a large document that contains an enormous amount of dense information, it is important for patients and physicians everywhere to understand what is contained in this document because it bears important implications regarding how physicians will be compensated and the ability of patients everywhere to access quality healthcare. With this in mind, a MACRA summary is below.
MACRA Repeals the Sustainable Growth Formula
One of the problems that many patients with Medicare have noticed in recent years is that it is challenging for find physicians who accept Medicare as a form of payment. Much of this issue can be credited to the dysfunctional and out-of-date sustainable growth formula, also known as the SGR. Over the years, this complex formula has made it challenging for physicians to receive fair compensation for the services that they provide. As a result, many physicians decided not to accept Medicare patients. MACRA repeals the SGR and replaces it with a different form of physician compensation. The result is that physicians are compensated more easily for the work that they provide, meaning that patients with Medicare should have an easier time finding physicians who will accept their form of health insurance.
MACRA Alters the Fee for Service Model
Another important implication of MACRA is that it changes the fee-for-service model. For those who might not know what this model is, the fee-for-service model has been around for decades and compensates physicians for the services that they provide; however, one of the problems with this model is that it doesn’t take into account the quality of the patient outcomes. It purely pays physicians based on the number of patients seen and what services they delivered to those patients. In recent years, there has been a push to take into account the quality of the patient care in addition to the services that physicians provide. The Medicare Access and CHIP Reauthorization Act paves the way for physicians to be compensated based on the quality of the service that they provide.
MACRA Includes Four Different Categories that Impact Physician Reimbursement Rates
When physicians and patients hear that doctors will be compensated based on the quality of the care that they provide, physicians might be wondering how this is determined. The different categories that MACRA will examine include the quality of patient outcomes, the advancement of care information, the clinical improvement activities of the practice, and the use of medical resources by the physician practices. All of these different categories are placed into a composite score that is evaluated by the CMS and determines the bonuses of penalties that the practice might receive. The goal of these different categories is to push physician practices to take into account the quality of the healthcare that their patients receive in addition to the number of patients that the practice sees.
Overall, MACRA is a dense piece of legislation with many different details that are challenging for everyone to understand; however, this is an important summary of some of the major points contained in the document. This promises to dramatically shift the way physicians take care of Medicare patients but has not yet been applied to Medicaid patients. Without a doubt, the governing body will be evaluating how physician practices respond to MACRA and alter the legislation down the road.