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.
We all know healthcare is changing, and the driver for much of this change is the government. MACRA (Medicare Access and CHIP Reauthorization Act of 2015), the latest sweeping healthcare reform law from Congress, is being massaged by CMS, and while most believe it is the physician at the tip of the MACRA spear, it will have a profound impact on pharmacists, too.
MACRA will fundamentally change how providers are paid. It’s about time. Fee-for-service, the “do more, get more” reward system that has sent us into an economic tailspin in healthcare may finally become a thing of the past. Under value-based payment, the foundation of the reward system will be quality. This change in philosophy, from volume to value, and the change in economics, requires a shift in the existing relationships among stakeholders.
There is sweeping new federal regulation that will impact the future role of managed care nurses and physicians in the most challenging of ways. This new law is referred to as “MACRA.”
MACRA will overwhelmingly affect pre-authorizations, clinical coding review, claim reimbursements, policy development, performance measures and coordination of care, defining new roles for Medicare providers and managed care professionals in the United States.
Commenting on the imminent release of a final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt anticipated this new healthcare policy will give providers a “proliferation of opportunities.”
The final MACRA rule is expected to be released by CMS on or about November 1. It will implement the Quality Payment Program (QPP) that will replace the Sustainable Growth Rate governing Medicare reimbursements for providers treating Medicare beneficiaries. The QPP promotes value-based, coordinated care over the traditional fee-for-service method. It requires that participating practices cite progress through measures of performance.
While most healthcare providers agree the move toward fee-for-value is a positive advance for the healthcare industry, this shift away from fee-for-service isn’t coming without its challenges.
That’s especially true for providers who serve patients in rural and underserved areas and now must implement changes dictated by the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA.
