Most people who have paid any attention to the news recently have realized that healthcare continues to take up a substantial amount of the spotlight and for good reason. While the Affordable Healthcare Act (ACA), also known as Obamacare, generated a significant amount of controversy, the recently proposed plan by the Republican party has generated even more debate. Lost in this debate is the Medicare Access and CHIP Reauthorization Act, also known as MACRA. For people who haven’t heard of this act, it could have a significant impact on their ability to see a doctor. It is essential for physicians and patients alike to understand this act going forward.
An Overview of MACRA
The Medicare Access and CHIP Reauthorization Act (MACRA) became law in April of 2015. It was passed with support from both of the country’s major parties and changes the way the government compensates physicians for their work. In addition to changing payment plans, the law also established funding for new technology to be developed and tested and changed the way advisory groups examined the function of the United States healthcare system. Overall, it represented a paradigm shift in Medicare funding and its associated subsidiaries. Without a doubt, MACRA has changed the healthcare landscape for patients and physicians.
Why it Matters: The Benefits
MACRA has numerous benefits for patients and physicians and while it is a complicated piece of legislation, most people who have read the law understand that it is significantly better than the sustainable growth formula (SGR) that the government used to use to compensate physicians. A major benefit of MACRA, the SGR formula was overly complex and it was repealed when MACRA was approved. Under the SGR formula, physicians had a difficult time understanding how they would be compensated for seeing patients with Medicare. Because they couldn’t understand the formula, many physicians decided not to see patients on Medicare. This limited patient access to Medicare.
By passing MACRA, the government has ensured that the millions of patients on Medicare would have access to physicians who are now open to treating patients on Medicare. If MACRA hadn’t been passed, physicians would have received a major pay cut for services that they provided to Medicare patients. In response, doctors would have refused to see Medicare patients, limiting patient access. MACRA ensures that the millions of people on Medicare will have choices when it comes to their physicians.
In addition, MACRA focuses on patient outcomes instead of the number of patients seen. For decades, physicians operated under a fee-for-service model. This means that physicians are compensated based on the number of patients seen. While this model has its pros and cons, one of the major issues with this model is that it does not consider the quality of the service that has been provided. Under MACRA, doctors can receive bonuses or be penalized based on the outcomes of the patients that they see. If doctors provide exceptional patient care, they will receive a payment bonus under MACRA. This incentivizes physicians to provide quality care instead of trying to see as many patients as possible.
Finally, MACRA also pushes hospitals and physician practices to focus on new pieces of technology that might improve patient outcomes. There is a major issue among physician practices and hospitals across the country in that their electronic medical record systems do not talk to each other. This makes it a challenge to send records between different systems if patients travel to different physician networks. MACRA encourages hospital networks and physician practices to use systems that will talk to each other. This makes it easier for medical systems to share information about patients, leading to improved patient care.
MACRA and Quality Improvement
Improvement of Quality – indicates successes when meeting goals, but also reveals inadequacies
Transparency – shows stakeholders what they want to know without having to dig through mounds of data, as well as providing patients with information on the organization from which they are receiving care
Accreditation – brings to the forefront certifications presented by outside agencies that indicate standards are being met
Participation in Financial Incentive Programs – attests to the ability of the organization to meet requirements for reimbursements to the maximum percentage when that organization has met minimum standards consistently. Also, indicates that the facilities have adapted to the new technology necessary to achieve such standards. Pinpointing areas in need of performance improvements is much more easily stated than actually found. Biases come into play and many organizations are bogged down with an overabundance of data that has more value as scrap paper rather than informative data, sometimes known as spreadsheet overload. Missing out on the realization that there are problems or at least problematic areas leads to waste and lower satisfaction in patient care and outcomes. For this, you may want to seek outside analysis and involvement.