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MACRA: Obama's Other Health Success
2019-01-07 15:58:45
Liza Tan

[메디컬리포트=Liza Tan 기자]

In any conversation regarding President Barack Obama's legacies, the Obamacare (AKA the Affordable Care Act [ACA]) will certainly be one of those mentioned.Why?Because it was a monumental achievement in America's history, and it enabled Obama to succeed where his predecessors have failed.It is was one of the issues during President Donald Trump's presidential campaign last year.

Whatever the outcome for Trump's revision or amendments to the law, one bipartisan bill for the United States healthcare reform was passed by both houses of Congress and President Obama.The bill known as the "doc fix" bill was eventually came to known as "MACRA," or the Medicare Access and CHIP Reauthorization Act of 2015.

Two years have passed since the signing of the bill and majority of providers are still not aware that MACRA exists.

This article should indeed shed some light about MACRA's features and intent.

The Bill

In a Policy and Medicine article entitled "Understanding Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM’s)," it was stated that MACRA has nullified the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula by substituting it with the Merit-Based Incentive Payment System (MIPS).

MIPS is engineered towards gauging Medicare Part B providers on an annual basis, and four categories will be utilized to formulate a "MIPS score."  Meaningful Use (MU) [25 points], Value-Based Modifier (VBM) quality based upon Physician Quality Reporting System (PQRS) measures [30 points], VBM cost [30 points], and "clinical practice improvement" [15 points] will constitute the four areas that will determine the score.

In terms of transparency, the Physician Compare website will feature the MIPS scores, the individual category scores, and the scope of all scores for eligible professionals.

Physicians, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists are qualified for MIPS, and more professionals, such as physical or occupational therapists, speech language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians or nutrition professionals, will become eligible for MIPS two years from now.

The Centers for Medicare & Medicaid Services (CMS) mentions that the Quality Payment Program is geared towards making Medicare better by helping people focus on care quality and making patients healthier.It will also cater new tools, models, and resources to help medical staff provide patients with the best potential care.Other than MIPS, medical staff can also pick the Advanced Alternative Payment Models (APMs).

In addition, MACRA also required the removal of Social Security Numbers (SSNs) from all Medicare cards so that private healthcare, financial information, and federal health care benefit and service payments can be well secured.

The MIPS Quartet

1.) Meaningful Use (MU)

- It is a method of utilizing certified electronic health record (EHR) technology to tune up healthcare's quality, safety, and efficiency and reduce health disparities.It is also anticipated to better engage patients and their families in the healthcare they receive and improve care coordination and sustain the patient health information's privacy and security.

2.) Physician Quality Reporting System (PQRS)

- A program designed to motivate individual eligible professionals and group practices to relay information regarding the quality of their provided care to Medicare.The program awards participants the chance to gauge the level and quality of care served to their patients.

In terms of criteria, the following must be considered in choosing the variety of measures to report:

- Clinical conditions treated;

- Types of care provided (preventive, chronic acute);

- What kind of setting the care is delivered in;

- Quality improvement goals for the following year; and

- Other quality reporting programs that are currently in use, or currently being considered.

3.) Value-Based Modifier (VBM)

- This program permits a differential payment to be made to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) with quality of care provided versus the cost of care as criteria.This will be also used to configure Medicare PFS payments to non-physician eligible professionals.In the end, this is an adjustment crafted on a per-claim basis to Medicare payments for items and services.

4.) Clinical Practice Improvement Activities (CPIA)

- The final basis is defined as "an activity that relevant eligible professional organizations and other stakeholders identify as one that improves clinical practice or care delivery." This area gauges healthcare professionals on "their effort to engage in continuing education and working to improve their practices and facilitate future participation in APMs."

CPIA will be determined using:

- Expanded practice access

- Population management

- Care coordination

- Beneficiary engagement

- Patient safety and practice assessment

- Participation in an APM

- Other criteria as determined by the Secretary of HHS

Advanced Alternative Payment Models (APMs)

APMs provide CMS with new modes of payment towards healthcare providers for their services towards Medicare beneficiaries.Being a physician or a practitioner who has a percentage of patients or payments will qualify them as APM participants.

A lump-sum incentive payment, an increased transparency of physician-focused payment models, and higher annual payments are some of the APM's benefits.

Until Today

An HIT Consulant article entitled, "7 Healthcare Trends to Watch in 2017," has listed down the healthcare trends that healthcare professionals should encounter.

On top of its list is MACRA.

The article mentioned that MACRA "has been one of the most significant federal legislation in the US healthcare arena" since physicians and payers share a common belief that MACRA is transformative as it will change the way providers will get paid in America.

It is also emphasized that physicians must be educated, aware, and knowledgeable about the gaps concerning what they have performed, and what MACRA requires.

Despite being expected to take full effect from the start of this year, CMS delayed its full implementation and has allowed practices to partially join.

The article highlighted the trifecta of major concerns:

1.) Majority of providers are unaware of MACRA's existence

2.) The daunting task of expanding it to rural and small practices, and

3.) The implementation itself since it is a document composed of 2,400 pages.

With the Obamacare currently at the mercy of the Trump administration it is believed by some pundits that it is only a matter of time before Trump sets his sights on MACRA.


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