Minding MACRA

Is MACRA the new SGR? Thankfully not. But that doesn’t mean you can ignore it.

MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. It replaced the Sustainable Growth Rate formula, which by this year threatened to cut the physician fee paid by Medicare by north of 20 percent. MACRA instead will allow a 0.5 percent increase in reimbursement for the next few years.

But as several presenters at the MedAxiom Cardiovascular Service Line Symposium in Atlanta stressed this week, that modest boost turns into a loss when you consider inflation. Add to that the potential penalties for quality initiatives such as 30-day readmissions for heart failure, acute MI and in the next round, CABG. At the same time, the Centers for Medicare & Medicaid Services is shifting from rewarding participation in initiatives such as Meaningful Use to penalties for laggards.

This is all part of the shift from volume to value. As Brad Kruger, MBA, vice president at Aurora St. Luke’s Medical Center in Milwaukee said, the transition for physicians and administrators is now like "being in two canoes going down the river with a foot in each one.”

It is not only a question of when to leap but how to avoid tipping over in the process. Two more acronyms will come into play: MIPS, for the Merit-based Incentive Payment System; and APM, the Alternative Payment Models. MIPS and APM are works in progress. Think of them as elements in the current propelling healthcare toward the goals of high quality and low cost.

It might get choppy or it might flow smoothly. Keep in mind, even in a glassy-flat current, you can get dumped in the river if you aren’t aware. So follow MACRA, MIPS and APM. They aren’t just acronyms. They are your new and future reality.

Candace Stuart

Editor, Cardiovascular Business