In April 2016, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA). Voluntary reporting by practitioners began in 2017, and this year additional provisions came online, furthering the fundamental changes in the way CMS compensates health care providers in the United States.
This shift away from Medicare’s previous sustainable growth rate (SGR) model toward a value-based model represents a major milestone in the ongoing effort to provide reliable, quality health care for U.S. citizens.
As a hospital executive, you probably understand the central tenets of the new law — replacement of the SGR formula with the Quality Payment Program (QPP) and the two-track system by which providers can choose to participate: the Merit Incentive Payment System (MIPS) or Advanced Alternative Payment Model (APM).
You also know that by shifting to one of these payment methodologies and providing high-quality, cost-effective patient care, CMS provides either financial rewards or penalties with increasing proportions of risk/reward each year. Under the current program, the provider’s Medicare revenue at risk grows incrementally up to nine percent by 2022.
Is Your EM Group Prepared?
Based on this knowledge, shouldn’t you be asking if your EM management group is prepared? If not, the financial risk could put more pressure on your hospital. To assist with your discovery, here is a list of seven questions that should be part of that conversation:
- How is your group planning to approach the requirements and opportunities inherent in MACRA?
- Did you participate in the precursor to MIPS ( which is PQRS)? If so, what were the results, and how did they compare to other groups?
- How do you ensure that your providers know how to succeed? What feedback do you give them? How do you know it is effective?
- When quality measures change, how quickly can you get your group of providers up to speed? How do you do it?
- If you perform well under MACRA, who benefits and how?
- If you perform poorly under MACRA, who could be affected? How?
- As a partner, how can I help?
The implications of MACRA are clear: As a hospital executive, to succeed in this new environment, you need to be entirely sure your house is in order. Based on their answers to your questions, if you have any doubt whatsoever that your EM practice management group is prepared to face this increasingly important reimbursement reality, consider giving our consulting group a call.
The SCP Advantage
Thinking beyond MACRA and into the future is our goal at Schumacher Clinical Partners. Our consulting group excels at helping hospitals and health systems like yours.
Whether your organization is consolidating, expanding, or adapting to comply with regulatory requirements, optimizing clinical performance, or implementing a new technology solution, we have the expertise to craft and carry out thoughtful strategies that allow you to thrive within chaos.
Today, the issue might be MACRA, but who knows what tomorrow could bring? Whatever challenge we take on together, you can expect SCP to deliver expert advice tailored to your organization along with innovative, actionable strategies designed to bring positive change to your bottom line.
Visit these resources to learn more about MACRA and help your organization prosper in the face of constant change:
- Nine Things Healthcare Executive Should Know About MACRA (Managed Healthcare Executive)
- What Is MACRA and What It Means to Providers, EHR Technology (EHR Intelligence)
- MACRA: MIPS & APMs (CMS)
- Quality Payment Program website (CMS)