Medicare & Medicaid

Why MACRA matters for your practice

Troy Parks , News Writer

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the notorious sustainable growth rate (SGR) formula last year, but what will the new MACRA payment policies mean for your practice? Three experts offered answers to this question and detailed what physicians can do now to shape these changes themselves.

Payment changes coming under MACRA

“While we are thrilled that Congress finally did away with SGR, it is very important that we take a closer look at what was adopted in its place,” said Barbara L. McAneny, MD, immediate past-chair of the AMA Board of Trustees and an oncologist in New Mexico.

MACRA creates a new framework that was designed to offer physicians a choice between a modified approach to fee-for-service and transitioning to alternative payment models (APM), and physicians can offer their insights on these choices as they are being developed. Those who choose to stay with the fee-for-service model will see their payments increased or decreased under the new Merit-Based Incentive Payment System (MIPS).

“MIPS is going to adjust the fee-for-service payments based on a number of factors including, clinical practice improvement, quality, judicious use of resources and use of electronic [health] records (EHR),”Dr. McAneny said.

“Performance measures are not new,” said Richard Hellman, MD, a clinical endocrinologist in Kansas City, Mo., and a past-president of the American Association of Clinical Endocrinologists. “But what you use these performance measures for is to improve your practices … and work together as a team.”

“One of the things that the outside world doesn’t know,” Dr. Hellman said, “is the fact that ours is a very dynamic profession. There’s science coming in, there are new concepts coming in—things change.” Performance measures need to reflect that, he said.

Physicians are able to elect to participate in alternative payment models (APM) as an alternative to the MIPS, Dr. McAneny said. “Well-designed APMs can allow physicians to provide better care to their patients, lower health care costs in general and improve the financial bottom line for the practices.”

“I have seen the potential for APMs first hand,” Dr. McAneny said. “I led the design and implementation of an oncology medical home model, which received a health care innovation award from CMS. The grant allowed me to show that physicians have the ability to prove that we can provide better care at a lower cost if we are given the tools to do so.”

What physicians can do to make the system work for them

The Centers for Medicare & Medicaid Services (CMS) announced three changes it is making to ensure these new systems are better for both physicians and their patients. It is important that physicians get involved right now in the development of performance measures and APMs that work as they need them to rather than leaving it to the government to design these tools.

Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform and one of the 11 members of the federal Physician-focused Payment Model Technical Advisory Committee (PTAC) created by Congress to advise the Department of Health and Human Services on the creation of APMs under MACRA, spoke to physicians on how to create a physician-led health care future.

“SGR is dead, and we need to keep the sword sharpened,” Miller said. “If [we] continue to [let] happen what is happening today … we’re going to continue to get what we’re getting today,” Miller said, “which is small physician practices and hospitals being forced out of business, high prices from those who are left, shifts in care to higher cost settings, overuse of expensive procedures, loss of innovation, large increases in insurance premiums and patients who can’t afford their care.”

“If we have a physician-led future, that could change,” he said.

“I think the most efficient health care delivery entities in the entire world are small physician practices,” Miller said to applause. “If we let them go, we will regret it.”

“Alternative payment models, if they’re designed well, can be win-win-wins,” Miller said. “They can be wins for the payer because of lower spending; they can be wins for the patient because they’re getting better care without unnecessary services; and they can be wins for the physicians because they’re getting paid adequately to deliver high-value services.”

Now it is up to physicians to work closely with their medical specialty societies to design APMs that will work for their practice, improve their patients’ care and meet the MACRA standards that are soon to be set by CMS. Find out how you can work with your specialties to design APMs that are broadly applicable.