Some people have heard of it and are deeply worried. Others are ignoring it or don’t believe it will really affect them. Still others see it coming and are wondering what they can do about it. Whether you like it or not, the Medicare Access and CHIP Reauthorization Act (MACRA) begins in January of 2017, and could dramatically impact your Medicare and Medicaid reimbursements in the future.

What Is MACRA, Anyway?

MACRA is the new way the government will be determining medical reimbursements in the future. Starting in 2017, there will be four major criteria used to composite a “score” determining a physician’s compliance to the program and, as a result, his or her reimbursements. In 2019, the government will look back over the last two years of compliance and determine whether your reimbursements will remain the same, increase, or be cut. These scores are also intended to be public, so patients can use them to help find a doctor—though there isn’t evidence that people will actually use them that way as of yet.

So what, exactly, is going on? Well, the idea is to switch from the fee-for-service model of reimbursements doctors have been using to a “Value Based Medicine” approach. The theory is that fee-for-service models are based on the volume of patients you see over time, while Value Based Medicine will measure reimbursements more on the quality of care you bring to the table. Theoretically, this is supposed to encourage a high quality of care while reducing the cost of medicine for the government.

While this is a big shift for physicians, the steps for this have already been put into place, albeit under different names. You see this in the four major components that the government will use to “score” a physician and determine his or her unique reimbursement pay scale. The criteria are:

  • Quality (50% of your score) – This is determined by submitting measures on Medicare patients. Currently these are known as PQRS measures.
  • Advancing Care Initiative (25% of your score) – Right now, this is known as “meaningful use,” and it uses your EHR to measure patient care.
  • Clinical Quality Improvements (15% of your score) – Physicians will have to do specific things based on their specialty. (This hasn’t been well-defined for podiatry yet.)
  • Cost (10% of your score) – This is how much it costs the government for you to treat patients, relative to your peers.

Should I Be Worried? How Can I Possibly Comply?

The whole topic is complicated and has many doctors worried, but it isn’t the end of the world, or even the end of private practice. MACRA is a unique business decision for you, and needs to be treated as such. 100% compliance in every possible area may not benefit you as much as it will cost you, given your current staff, your workflow, and so on. Fortunately, these are not “all or none” components to the program. You can be partially compliant. You have to figure out your unique cost/compliance balance to determine what you need to do to maximize the MACRA benefits (or minimize its penalties) for your individual practice.

You don’t have to face these decisions alone. You need data, and an understanding of how to interpret that data. This is where the Virtual Practice Management Institute (VPMI) program comes into play. Through the partnership with Top Practices and Collaborative Practice Solutions, we can help you get the data you need, as well as coaching and mentoring to know how to use that information to make the right business decisions for your practice. Contact Top Practices for more information today by e-mailing [email protected] or calling (717) 725-2679. MACRA will affect you, but you can be prepared, so don’t wait until the penalties hit to make the changes you need.
Rem Jackson
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Founder and CEO of Top Practices, LLC
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