The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was designed to change the way healthcare is paid for. True to government form, it is about a 1,000-page rule drafted by the Centers for Medicare & Medicaid Services (CMS) that is meant to provide the working guidelines of its implementation.
With bipartisan support, the federal legislation was signed into law Apr. 16, 2015. Fundamentally, the law establishes new ways to pay physicians who provide care for Medicare patients. It also includes funding for development and testing, new programs and requirements for data sharing, and it establishes new federal advisory groups.
MACRA is set to take effect Jan. 1, 2017.
Essentially, MACRA repeals the Sustainable Growth Rate (SGR) Formula that has determined Medicare Part B reimbursement rates for physicians and replaces it with new payment models. Under MACRA, participating providers are paid based on the quality and effectiveness of the care they provide — value-based care — rather than the fee-for-service model, which has dominated healthcare for decades.
MACRA rules — and their corresponding payment measures — only apply to Medicare Part B payments, but that can obviously change as the regulation progresses. Also, to manage patient care, providers will be reliant on accurate data from multiple delivery systems, which must find a way to communicate across disparate systems.
However, because final rules on the legislation and its implementation are expected in November, there is still caution from some leaders in healthcare. During a Senate hearing July 13, CMS Acting Administrator Andy Slavitt said his agency, as well as many legislators, understand the desire and need to slow down plans for implementing MACRA.
Slavitt told members of the Senate Finance Committee that he understands that small physician practices "might not have enough time to prepare for the important changes in Medicare payment if they go into effect on Jan. 1 as planned."
Some have been critical of the aggressive timeline of final rule announcement and the quick turnaround of the program's implementation, including outspoken Sen. Orrin Hatch (R-Utah).
"Physicians will only have about two months before the program goes live," Hatch said. "This seems to be a legitimate concern. What options is CMS considering to make sure this program gets started on the right foot?"
Slavitt said, ultimately, the final program rollout might be delayed, and that "CMS is open to alternatives that include postponing implementation and establishing shorter reporting periods."
CMS is not slowing down enough, others say. American Academy of Family Physicians (AAFP) is lobbying for a delayed implementation of MACRA until 2018 and set aside 2017 as a preparation year. Slavitt suggested that reporting requirements could be adjusted to ease the burden on physicians. For instance, CMS could obtain data through an automated database such as a registry.
Given the contention around the regulation and its confusion and massive undertaking, the next six months are likely going to be busy ones for regulators and physicians alike.
