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Sifting through the hype surrounding MACRA to understand the possible fallout; experts weigh in

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Many providers claim CMS' Medicare Access & CHIP Reauthorization Act of 2015 will serve to providers' detriment despite promises MACRA will improve patient care while driving down costs, according to MedPage Today.

Various experts discussed MACRA and its ensuing consequences at a briefing in Washington, D.C., which Brookings Institution and the American Enterprise Institute sponsored.

Under MACRA, physicians can participate in the Merit-Based Incentive Payment System or the Alternative Payment Models. MIPS consists of a weighted score of quality, resource use, meaningful use and practice improvement scores. Physicians have the opportunity to receive financial bonuses if they obtain good quality outcomes. However, many may face penalties if they fail to meet CMS' requirements.

One expert noted, "Doctors are going to be livid when they absorb the fact that they spent so much political capital to enact MACRA only to find out ... that under the current payment system, doctors are going to get paid less; that gap will grow over time."

Another expert referred to MACRA as a "gigantic illusion," and CMS will have to update the payment system, as the way in which CMS penalizes or reimburses providers may draw stark criticism from the medical community.

Initial estimates anticipated CMS' Merit-Based Incentive Payment System would provide bonuses or penalties to nearly 102,788 solo practitioners. Of that figure, nearly 87 percent would face MIPS penalties in 2019. To help providers succeed under MACRA, HHS is providing $20 million for Medicare small group providers to receive sufficient training and education, but many still wonder if this will be enough.

Alice Rivlin, PhD, a senior fellow at the Brookings Center for Health Policy, said MACRA should bring patients into the mix, and motivate patients to also work to drive down healthcare costs. She also suggested CMS start competitive bidding in Medicare Advantage plans. Additionally, experts noted the fact the government and the public are failing to understand upcoming problems that may lead to a financial crisis. For instance, our nation has an increasing aging population who will require professionals to address their serious needs, and the healthcare industry is not sufficiently prepared for this, one expert argued.

Robert Moffit, PhD, senior fellow in the Center for Health Studies at the Heritage Foundation, said our nation is "sleepwalking into a fiscal crisis," and healthcare therefore needs to work to amend Medicare's financing problems.

Overall, experts remain skeptical of healthcare's future and providers ability to succeed other MACRA, leaving many to wonder if the industry was too quick to jump on the MACRA bandwagon.

More articles on coding & billing:
HHS allots $20M to help small practices succeed under MACRA: 5 key points
Medicare funds depleting fast; may run out of funds by 2028: 5 things to know
Obama administration deems new GOP health insurance proposal 'not worthy' — 4 takeaways

 

 

 

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