Will MACRA Fall Victim to Repeal and Replace?

I've just returned from the National MACRA MIPS/APM Summit in Washington, D.C., where the overarching discussion centered on how to create and implement strategies that pay physicians fairly, while controlling spending in the Medicare program. It's a question we've wrestled with for almost 20 years and a challenge we must solve.

The Medicare Access and CHIP Reauthorization Act of 2015 replaces the Sustainable Growth Rate, which was almost universally hated because of annual threats of cuts in physician payments. MIPS, the default portion of MACRA, seeks to retain the basic fee-for-service payment structure and stabilize physician payments, while at the same time requiring adjustments to the size of the payments based on a physician's ability to improve performance and control costs. The APM track is designed for providers who are already operating value-based models. Ultimately, MACRA is designed to create a healthy business model for physicians while also creating healthy populations.

As I listened to the summit's highly respected speakers, they confirmed my belief that our healthcare system has been broken. We simply cannot return to the pre-ACA world of rapidly increasing costs and declining health outcomes. We must move forward, and I believe that MACRA is a step in the right direction—even with its difficulties.

Will MACRA, MIPS and APMs Survive?

Under the Obama administration, it was easy to predict the future of MACRA. Its future in a Trump administration is less certain, but I think we have a couple of clues to its ultimate survival:

  • MACRA and its component parts, MIPS and APMs, were passed with significant bipartisan support. Because of that support, it seems likely that MACRA will survive this Congress.
  • Two criticisms of MACRA are the upcoming deadline for implementation and the lag time between reporting deadlines and the use of the data. Because of issues such as these and the time a new administration may need for review, we are likely to see tweaks to MACRA or slow-downs for implementation, but implementation will occur.
  • Regardless of political or ideological arguments against MACRA, Mike Leavitt, former governor of Utah and HHS Secretary in the George W. Bush administration, said we must respond to the economic imperative to change. An unhealthy population with soaring medical costs is detrimental to the country's ability to compete.
  • Remember why we're doing this. The old system wasn't working and devising a way to reimburse physicians fairly, control costs and improve the quality of care benefits all stakeholders.

What Action Should You Take Now?

Throughout the summit, I heard the same advice to physicians and other providers: Don't stop or slow your MACRA implementation and continue your work to meet upcoming deadlines.

We don't know how the details may change in the coming months, but you do not want to miss the opportunity for higher reimbursements because you didn't meet existing deadlines. For example, if you report to some measure or activity during 2017, you won't be hit with the 4 percent penalty. Waiting to see what happens is not a productive business strategy.

What Will the Future Hold?

Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, said during the summit, "Health is not partisan." I agree with him.

I also recognize that it's possible for different paths to lead to the same destination. We must, however, keep our goal in mind or risk getting lost. An old adage warns, "If you don't know where you're going, any path will take you there."

I think the Triple Aim is still an effective guidepost for us. It's beneficial to stop and remember that our ultimate goal is better care for individuals, better health for populations, and lower costs for healthcare overall.


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Topics: APMs, MIPS Healthcare, MACRA Summary

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