MACRA and MIPS are Coming - Are You Ready?

MACRA and the changes anticipated in provider reimbursement have risen to the top of mind for many of us working in PALTC (post-acute and long-term care). This is actually true across a broad spectrum of health information markets, as the impact is both broad and deep. Let me briefly explore some of the reasons I think this is true.

First is the breadth and size of the impact. Virtually every provider that serves Medicare patients is impacted by the new reimbursement methodology. As the program matures there could be as much as a 20% difference in Medicare reimbursement rate between the high-achievers and the low. In PALTC where the bulk of care is covered by Medicare, that difference is profound.

Second is the degree to which practices will be impacted. Providers must begin to demonstrate behaviors that positively impact the cost of care, the quality of service, efforts to improve their practice in a regular and systematic fashion, and implement health technology to serve these “Triple Aim” goals. Those are the requirement of the MIPS (Merit-Based Incentive Payment System) option under MACRA. The other path, which is not likely to be practical in the early years of MACRA for most practitioners is to generate a major portion of one's Medicare revenues via an Alternative Payment Model.

Third, this is happening fast. Current requirements will have measurement begin in 2017 (yes, the entire year and not just 90 days of reporting) with incentives and penalties being imposed in 2019. For several years the impact of the potential payment adjustments, both positive and negative, will grow. As stated above, there are large amounts of money “at risk”.

Fourth, the impact of MACRA extends well-beyond providers. This week saw a number of articles examining the impact that the new regulations may have on Patient Engagement. Efforts to bring a higher level of participation and patient engagement are perceived to be less well supported in MACRA and this has a lot of patient advocates concerned.

I am happy that many people and health care periodicals have written on MACRA and its impact. While no one has a clear crystal ball view of the ultimate outcome, and many fear the worst, only time will tell the net result of this massive overhaul of reimbursement methodologies and the health technology that supports (and hopefully promotes) effective post-acute and long term care.

Hold on to your hat!