CMS continues to ease administrative burdens for physicians as the “slow ramp-up” of the Quality Payment Program continues in 2018, according to the agency’s proposed rule for MACRA’s 2018 Quality Payment Program.
The American healthcare system is in a state of uncertainty. And it is failing patients.
At least that’s the assessment I’ve frequently come across over the past few weeks. Roiling politics and the resulting policies seem to be the root of this uncertainty. Be it the changes ushered in by the Affordable Care Act (ACA) or the looming changes brought by the election of Donald Trump and a Republican-controlled Congress, it seems that healthcare will be in a state of flux and disarray for the foreseeable future.
By James (Larry) Holly, M.D., CEO, Southeast Texas Medical Associates
To be successful, the implementation of new policies and initiatives that will produce the future we imagine must be transformative – which comes from within.
Transformation results in change that is not simply reflected in shape, structure, dimension or appearance, but is also part of the nature of the organization being transformed. The process itself creates a dynamic which is generative. It not only changes that which is being transformed but it also creates within the object of transformation the energy, the will and the necessity to sustain and expand that change and improvement. Transformation is not dependent upon external pressure (rules, regulations, requirements) but is sustained by an internal drive which is energized by the evolving nature of the organization.
They say that “states are the laboratories of democracy.” In no place is this more evident than the state of Vermont’s efforts to radically change their healthcare delivery system.On October 26, CMS and Vermont’s Green Mountain Care Board (GMCB) jointly announced the Vermont All-Payer Accountable Care Organization (ACO) Model. This new, first of its kind initiative is aimed at accelerating healthcare delivery reform for the entire state and its population by establishing a statewide ACO that is responsible for the health outcomes of its entire population.
If physicians don’t understand MACRA – or think they don’t need to understand MACRA – how will ACOs get physician practices to align with the requirements of the Patient-Centered Medical Home (PCMH) model?The transition from traditional fee-for-service to value-based payment models, and the focus on patient-centered medical care and population health, has driven the proliferation of Accountable Care Organizations (ACOs).
With the final MACRA rule released on Oct. 14, the industry is now getting the chance to dig into all of the details of this 2,300-page document, especially the act’s Quality Payment Program, which replaces the Sustainable Growth Rate formula with two tracks of reimbursement—the Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS).
“Folks are now in the process of getting their heads around what’s in the final rule and determining what they have to do to respond in 2017,” said Aaron Turner-Phifer, URAC’s director of government relations and policy. “The most important thing right now is for practices and clinicians to be engaging with their medical societies and educating themselves on the best path forward.”
Watch this video for quick overview about MACRA (Medicare Access and CHIP Reauthorization Act of 2015), and what you need to do to succeed in the new healthcare economy.
We all know healthcare is changing, and the driver for much of this change is the government. MACRA (Medicare Access and CHIP Reauthorization Act of 2015), the latest sweeping healthcare reform law from Congress, is being massaged by CMS, and while most believe it is the physician at the tip of the MACRA spear, it will have a profound impact on pharmacists, too.
MACRA will fundamentally change how providers are paid. It’s about time. Fee-for-service, the “do more, get more” reward system that has sent us into an economic tailspin in healthcare may finally become a thing of the past. Under value-based payment, the foundation of the reward system will be quality. This change in philosophy, from volume to value, and the change in economics, requires a shift in the existing relationships among stakeholders.