What is MACRA?
The Medicare Access and CHIP Reauthorization Act of 2015
Ms. Andria Jacobs is the Chief Operating Officer (COO), RN, MS, CEN, CPHQ, for PCG Software and has more than 30 years of experience in the healthcare industry, encompassing both administrative and clinical arenas. Prior to joining PCG, Ms Jacobs was the administrative director, of medical management for VertiHealth Administrators. Previously, she was an independent consultant in ambulatory care and practice management, where her clients have included hospitals, physician groups, and the University of California, Los Angeles.
What is the Goal of MACRA?
MACRA was designed to improve physician payment, MACRA was a step in the right direction, and certainly better than the alternative, but it’s not magic and was not enough. The act overrode the 21 percent pay cut due April 1, but it only provided a .5 percent annual pay increase starting June 1 for physicians and non-physician practitioners for five years. It also left no increases for five years (2015-2020). That doesn’t sound like a permanent, sound solution to me. Does a paltry half-percent pay raise make a significant difference in physicians’ ability to take care of Medicare patients and maintain healthy practices? Physicians weren’t happy about that size to raise and demanded better.
Issues with MACRA We see upon Inception
There was no language in the 300-page MACRA to finance repealing the payment formula. The Congressional Budget Office estimates the SGR overhaul would cost $175.4 billion between 2015 and 2025. MACRA will increase the budget deficit by $141 billion, saddling future generations with even more national debt in the trillions. The bulk of the offsets will be derived from Medicare reimbursement cuts to hospitals and post-acute care providers and increased beneficiary cost sharing, including elderly workers paying a greater share of Medicare Part B and Part D premiums.
MACRA is better than the sharp stick-in-the-eye pain the pay cut would have inflicted, but was it a viable solution long-term? Did they consider the escalating malpractice and overhead expenses and a rising conversion factor in years to come? No, they didn’t.
I’m still very concerned that doctors will refuse to take Medicare patients or require extra payments to continue providing service – or not even entering the medical practice field and opt to just simply join the next pharma company who has an R&D position open.
Passage of MACRA doesn’t end the physician payment debate. Now is not the time for blind acceptance and complacency. It’s time to stand back and ask how does MACRA affect hospitals and health plans? What does it mean to physician practices?
18 Years and We Got MACRA
The Centers for Medicare & Medicaid Services (CMS) and lawmakers took 18 years to solve the SGR problem and passed legislation at the last minute this year. Delayed decisions cause major administrative snafus and upheavals, rework, claims processing delays, payment backlogs, and interest accruals – not to mention mounting frustration among healthcare workers. Now is a good time to reach out to Congress or your CMS regional office and find ways to solve problems sooner, and to obtain timely updates, rules, and regulations. It is an opportunity to work closely with your local health plan organization or the AMA and other organizations to ask questions and find a permanent solution to Medicare physician payment. As HHS and CMS begin to implement MACRA’s numerous provisions, make sure your voice is heard for a successful outcome.
Time Will Tell
Only time will tell about the changes to MACRA that will come down the pipeline. What we at PCG know, is that any law passed in an expedited fashion is usually suspect to compliance, kick-backs, and questionable implementation. We can only hope that in years to come that we don't price our Providers right out of Medicare and Medicaid. Time will tell.
