The URAC Report

If physicians don’t understand MACRA – or think they don’t need to understand MACRA – how will ACOs get physician practices to align with the requirements of the Patient-Centered Medical Home (PCMH) model?

While many interested parties are watching how the legal action plays out in Texas with Teladoc’s federal antitrust lawsuit against the Texas Medical Board (TMB), there’s another way to address the issues other than regulations.

Recently, a number of parties filed friend-of-the-court briefs with the Fifth Circuit supporting Teladoc’s case, including the Justice Department and the FTC. And although the TMB has withdrawn its appeal, it plans to continue to fight Teladoc in the lower court.

The challenges for telehealth are significant, but the potential benefits are immense. The healthcare industry must address and overcome the issues – as we cannot afford to walk away from the benefits. 

“There are known and agreed-upon major and chronic health problems in this country,” said Kylanne Green, President and CEO of URAC. “Many Americans live with diabetes, obesity or multiple life-threatening conditions. Telehealth has demonstrated effectiveness against those health issues and many others.”

With the final MACRA rule released on Oct. 14, the industry is now getting the chance to dig into all of the details of this 2,300-page document, especially the act’s Quality Payment Program, which replaces the Sustainable Growth Rate formula with two tracks of reimbursement—the Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS).

“Folks are now in the process of getting their heads around what’s in the final rule and determining what they have to do to respond in 2017,” said Aaron Turner-Phifer, URAC’s director of government relations and policy. “The most important thing right now is for practices and clinicians to be engaging with their medical societies and educating themselves on the best path forward.”

Watch this video for quick overview about MACRA (Medicare Access and CHIP Reauthorization Act of 2015), and what you need to do to succeed in the new healthcare economy.

With accountability for patient outcomes increasingly spread throughout the continuum of care, pharmacies play a larger role than ever in delivering quality care.

A foundational principle of all healthcare providers is to keep the focus on patients and their specific needs. It’s also the philosophy at the heart of the Patient-Centered Medical Home concept.

For some physician practices, the demands of the Affordable Care Act have brought with them administrative and technical burdens, and an increasing number of providers are responding to that trend by consolidating with fellow practitioners.

Consumer advocates warn of the possibility of increased costs because of less competition due to consolidation, while others say it can advance the type of collaborative care that will improve patient outcomes.