Category: US Healthcare

The Question Many People are asking: What is MACRA?

What is MACRA?

MACRA which is an acronym for The Medicare Access and CHIP Reauthorization Act was established in 2015 and is enforced by the Centers for Medicare & Medicaid Services. MACRA was introduced is a solution to repeal the sustainable growth rate formula replacing a broken, frustrating and needlessly unpredictable system. This transition stabilizes Medicare payments and has the potential to reward physicians for what they do best— providing quality, high-value care.

MACRA provides education materials to customized practice insights, and help health practitioners get a clear view of their payment model options and their practice’s financial wellness throughout the payment and care delivery reform process. This article addresses some MACRA FAQs to assist health practitioners and clinicians navigate this transition seamlessly.

The Current State of MACRA Affairs

MACRA has established reporting demands that are very complex and hard to comprehend. MACRA comprises of over 2,400 (two thousand four hundred) pages of regulations. This makes it hard for physicians, nurses and health practitioners to interpret and understand these regulations and their implications. Failing to meet these requirements will have drastic implications on their organizations so understanding it is crucial. A survey was taken in 2016 to help determine the current state of MACRA affairs. The survey results showed that

48 percent of physicians plan to cut back on hours, retire, take a non-clinical job, switch to “concierge” medicine, or take other steps that would limit patient access to their practices. Breaking this down, 14.4 percent say they will retire in the next one to three years compared to 9.4 percent who said so in 2014.

Meanwhile, 21 percent will cut back on hours and 13 percent will seek non-clinical jobs. The conclusion from the survey results showed that doctors were dealing with a lack of moral due to invasive regulations and too much paperwork. Another issue is the fact that MACRA still does not have as much popularity as it should.

A large part of the industry is either unaware of MACRA or have heard of MACRA but have no plans or intentions of adapting it. According to the Deloitte Center for Health Solutions 2016 Survey of US Physicians, 50 percent of respondents said they have never heard of MACRA, while 32 percent recognize it by name but are not familiar with its requirements. Twenty-one percent of self-employed or independent physicians said they are somewhat familiar with the law, compared to nine percent of physicians employed by hospitals, health systems, or medical groups owned by them.

Answers to Some MACRA FAQs for Health Practitioners

Even those who know of MACRA and are willing to adopt it still have so many questions. The process of adopting MACRA is a long and convoluted journey filled with questions and sometimes confusion. Below are for frequently asked questions about MACRA and the answers to these questions

  1. Why is MACRA necessary?

  2. How do payments work?

  3. Who is required to participate?

  4. What if I don’t report at all?

  5. If I work in a large organization, do I need to worry about preparing for MACRA?

  6. Should I report as an individual or group?

  7. What about multi-specialty practices?

Why is MACRA necessary?

MACRA is necessary because of systems in the past subject doctors to negative payment adjustments and unfair penalties. MACRA stabilizes the reimbursement landscape and regularizes penalties reducing it from 11%(which is outrageous) to 4%.

How do Payments Work?

MIPS will be eligible for positive or negative Medicare Part B payment adjustments that start at 4% and gradually increase to 9%. This payment method will start in 2019 and go on till 2022. This payment distribution will be made on a  sliding scale and will not be affected by the budget. I.e it will be budget neutral. Instead, the payment adjustment will be made on a sliding scale and based on:

  • Physicians with a final score at the threshold will receive a neutral payment adjustment.
  • Physicians with a final score above the threshold will receive a positive payment adjustment on each Medicare Part B claim in the payment year.
  • Physicians with a final score below the threshold will receive a negative payment adjustment on each Medicare Part B claim in the payment year.
  • Physicians with a final score in the lowest quartile will automatically be adjusted to the maximum negative adjustment on each Medicare Part B claim in the payment year.

Who is required to participate?

MACRA is not just for Physicians. It’s also required for Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and groups that include clinicians who bill under Part B. Individuals who bill Medicare more than $30,000 and anyone already part of an Advanced APM will also participate.

What if I don’t report at all?

Those who don’t report will not only have to pay the 4% fine but also face a potential impact on their reimbursement, future job search efforts and lost reputation with potential patients.

If I work in a large organization, do I need to worry about preparing for MACRA?

Yes. There are many factors to this, so start your homework!

Should I report as an individual or group?

MACRA defines a group as a single Taxpayer Identification Number (TIN) with two or more MIPS eligible clinicians, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN. If you don’t fit this requirement then you should report as an individual.

What about multi-specialty practices, should they report as a group?

Most practices find it beneficial to report as a group as reporting individually will be a tedious process. Reporting as a group makes it relatively easier to achieve measures, such as care coordination, that require effective communication among providers, patients, and specialists. Everybody can participate in this.