Making Sense of MACRA – Patient Edition

Change is coming to the medical field that could impact the way services are delivered throughout the Borderplex.  Last year, Congress unanimously passed a new law known as the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA was passed with strong bipartisan support; President-elect Trump is not anticipated to affect its implementation.   For those not in the medical field, the simple explanation of the law is that it changes the way doctors are paid for Medicare. As such, it will have potential economic impact for our region.

In the past, most private practice doctors received their Medicare reimbursement on a fee-for-service basis. If they provided a treatment, they were paid for that treatment. Starting in 2019, Medicare Part B payments will begin to shift to a pay-for-performance basis.

In most cases, doctors who serve Medicare patients will receive their standard payment for providing a specific treatment. However, their rate of reimbursement will be modified by their overall performance on several quality measures.

In 2019, the financial adjustments will begin at 4% (adjusted up or down based on performance) and will grow to 9% by 2022.  Let’s say a doctor gets paid $100 for a treatment, his or her reimbursement could vary between $96 and $104 (in 2019), based on how “quality” is measured.

An important caveat – 2019 reimbursement modification is based on performance in 2017, which presents a challenge for doctors, who may not adapt quickly to the change. If they don’t report quality measures in 2017 and continue into 2018, they won’t be confronted with the consequences until 2019.

How will this impact our community?

Over four years, MACRA could swing Medicare Part B funding up or down by $129 million in the El Paso, Las Cruces, and Alamogordo area.

Best-case scenario.  If every doctor received the maximum adjustment in 2019 because of good performance, our doctors could be paid an additional $19 million.  This could help practices in our region better serve our community and plan for growth.

However, if they all received the maximum penalty, our doctors could lose up to $19 million in 2019.  Again, this could impact the types and ways they deliver medical services.

We need a strategy to keep that $129 million in our region. Otherwise, we literally will be sending that money to other communities. MACRA is designed to be budget neutral, meaning that the punishment for one doctor is the incentive for another.

The Borderplex Alliance, through its Life Science committee, is committed to leveraging our assets to build our regional economy. The committee, composed of Life Science leaders from across the region, understands the impact of MACRA and is seeking ways to help our medical sector to grow stronger.

How can we as a community make sure we bring home the MACRA bacon?

To succeed, doctors in our region need the right health information technology and the right expertise.  Doctors will need to track and report specific quality measures for MACRA, which is not straightforward. They will also have to make complex choices to ensure that they are on track to succeed. There are strategies that can help doctors automate their systems, prompt them to conduct screenings, and to aggregate data for reporting.

At the PHIX, we have developed a service line to help practices navigate these complexities. If you are a doctor trying to determine how to you can prepare for MACRA, feel free to call the PHIX offices (915-242-0674) and ask for information about our NAVIGATE services.

The healthcare infrastructure of the region will be better off if we plan now.

Jon Law is the Executive Director of PHIX. He is also the Chair of the Borderplex Alliance Strategic Plan’s Life Sciences Committee.

 
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