The MACRA Final Rule: What People Need to Know

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A couple of years ago, the federal government overhauled the healthcare system in the United States. While some people may be thinking about the Affordable Care Act, also known as “Obamacare”, this is actually in reference to MACRA, or the Medicare Access and CHIP Reauthorization Act. What this act did is do away with the hated sustainable growth rate formula (SGR), which pushed physicians to refuse to see Medicare patients due to its complexity and low reimbursement rate. With MACRA, the Medicare system has been overhauled, including compensation for the services that physicians provide. Recently, the government issued the MACRA Final Rule, or an executive document containing the most pertinent information from this piece of healthcare legislation. For people who don’t have the time to go through the document in its entirety, some of the most important points are contained below.

Who Does the MACRA Final Rule Apply To?

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The first question on everyone’s mind is whether or not this piece of legislation affects them on a personal level. For those who are wondering, the MACRA Final Rule only impacts patients who are on Medicare and the physicians who accept Medicare as a form of health insurance in their office. This legislation does not impact Medicaid patients or physicians who see Medicaid patients in any way, or patients that are on private insurance or cash paying for healthcare visits.

When Will the Payment Schedule Change?

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Physicians and patients may be wondering how the law will impact the cost of healthcare and the reimbursement rates for physicians down the road. MACRA incorporates a significant number of healthcare quality measures that could result in performance bonuses or performance penalties. Most physicians understand that the payment schedule will not change until 2019; however, the Center for Medicare and Medicaid Services (CMS) is going to start collecting data from physician practice performance in 2017. This information will be used to determine the payment schedule and reimbursement rates for services starting in 2019.

How Will the Quality of Patient Care be Judged?

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What many patients and physicians are wondering is how exactly the quality of care will be measured? While patients and physicians may prefer to be judged on the quality of their care instead of simply a fee-for-service model, it is important for patients and physicians to understand what the government will be assessing when they say that the quality of patient care will matter. The MACRA Final Rule is going to examine the performance of physicians with regards to the quality of their patient care in a few different categories. There will be an Advancing Care Information category (known as meaningful use in the prior model), Clinical Practice Improvement, Cost and Resource Use, and Quality of Patient Outcomes. These separate categories will be weighted differently; however, they will all have a significant impact on the reimbursement rates for physicians who see patients on Medicare. This will push physicians to focus on the quality of their patient outcomes, and how they got there, instead of focusing solely on the number of patients that they see.

What Exactly is the Clinical Practice Improvement Category?

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The MACRA Final Rule incentivizes physicians to invest time in improving the performance of their clinic in a variety of areas. MACRA provides a list of activities that physicians can engage in to improve their clinic and the clinic will receive points for each activity completed. If they hit a certain number of points, they will receive a bonus. Examples of activities that physicians can choose from include improved patient engagement, improved patient access, improved patient safety, emergency preparedness, and a focus on achieving health equity. Completing these activities should improve the experience of patients in the clinic and improve patients’ access to quality healthcare. Practices that complete enough activities will receive a payment bonus.

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