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MACRA Changes Start Now

UH Clinical Update - January 2017

By Cliff Megerian, MD, President, University Hospitals Physician Services

We know there will be many changes occurring in the health care industry over the next several years, if not months. The new presidential administration has stated that repealing and replacing the Affordable Care Act is a priority.

But there is one change that we definitely know will take effect in 2017, which has been in the works for many years. That is the change brought about by MACRA (the Medicare Access and CHIP Reauthorization Act), legislation that was passed in 2015 and takes effect this year.

MACRA is considered the second most important health bill signed into law by President Barack Obama (the other being ACA), but it is unlikely to be repealed by Donald Trump and the Republican Congress. MACRA is changing the way Medicare pays doctors by tying reimbursement to quality. And many believe that it will save money and improve quality, which is why it has received bipartisan support.

MACRA is considered the single largest regulation that will drive the business model for health care providers. It was designed to evolve the traditional fee-for-service Medicare payment model, which predominately has been based on volume, and to move it toward a value-based medical care system.

So how will this affect us? The law will fundamentally change how Medicare pays physicians and other clinicians who participate. It will establish two tracks for Medicare reimbursement. One is a merit-based incentive payment system (MIPS), which will affect providers who are reimbursed largely through fee-for-service. The other addresses the alternative payment model (APM) track. That second track is for physicians who take on a significant portfolio of APMs.

The value-based system, which can encompass either the MIPS or APM pathways, is designed to link patterns of reimbursement to the improved outcomes, quality and preventive care for our patients.

MACRA was designed to move physicians away from the fee-for-service approach to Medicare payments, and toward value-based medical care, which links reimbursement to an improved outcome for patients.

University Hospitals and UH Physician Services are working together to create the most advantageous scenario for our physicians. This will likely involve a movement toward an APM model, which can potentially shield physicians from some of the challenging and time-consuming aspects of the MIPS model.

The implications for all providers are clear: Physicians will be measured by something they may not think about every day, but something they certainly strive for: the highest-quality patient care and the best possible outcomes.