Since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed last spring, cardiologists and other providers have wondered how the legislation would change their reimbursement for treating Medicare patients.
The bipartisan bill repealed the sustainable growth rate formula and tied physicians’ compensation to providing quality care while also lowering costs.
Matthew Phillips, MD, FACC, the governor the American College of Cardiology’s (ACC’s) Texas chapter from 2013 to 2016, is one renowned cardiologist who is embracing the change. He wrote an editorial online in the Journal of the American College of Cardiology expressing his optimism about MACRA.
“In passing the MACRA legislation, Congress was actually quite ingenious in defining the details,” Phillips wrote. “The language leaves the determination of what is right to the physicians. This is brilliant. Compare it to Monopoly. If you were to develop a board game called Medicare Monopoly, how would you design the system to have the right incentives, encourage innovation, provide care for everyone with great access, maintain low cost, and encourage high satisfaction among providers and patients? In our field of cardiac and vascular medicine, what parameters would you have in place? What would you measure, and how would you do it?”
As Phillips pointed out, the details of MACRA have not been finalized and seem to be flexible. Still, he acknowledged that most cardiologists could improve their practices and focus more on evidence-based medicine. For insurance, some patients who could benefit from statin therapy are not on the medications, while others could benefit from an implantable cardioverter-defibrillator or could improve their blood pressure.
Phillips, the president of Austin Heart in Texas, mentioned two ACC registries that may aid physicians in tracking data and improving their care. The PINNACLE registry includes data on coronary artery disease, hypertension, heart failure and atrial fibrillation in an outpatient setting and provides physicians with online benchmark reports. He also cited the National Cardiovascular Data Registry as a useful tool.
“MACRA will be frustrating, and some may even view it as insulting, as the initial metrics will likely be very basic until new measures that accurately capture the complexity of patient care and outcomes can be developed,” Phillips wrote. “In the end, however, if MACRA results in an ongoing systematic review of the care we provide in any setting, my guess is that the results will be very helpful and interesting. In the new world, we will still be providing quality care. The difference now is that we will finally be able to prove it.”