NHRI CEO Elizabeth Mitchell Addresses Impact of Federal Healthcare Changes for Maine Providers

Elizabeth Mitchell, president and chief executive officer of the Network for Regional Healthcare Improvement, explored how upcoming national policy changes will impact Maine providers at the day-long Portland summit, entitled “Leading Change: How to Make the Switch from Volume to Value,” sponsored by the Maine Health Management Coalition and the Maine Medical Association on Nov. 18, 2015.

The healthcare payment tsunami called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will dramatically change how physicians in Maine and nationwide are paid. The current system pays doctors simply for care delivered, and rewards high-volume physicians. MACRA creates an innovative approach that incorporates the quality of care, cost, and whether patients benefited from treatment into the new payment formula.

The new system relies on a transparent healthcare system enabled by electronic health records, accurate data collection of clinical outcomes and costs, and engaged patients who will be asked to report their outcomes. The data allows providers, purchasers, and consumers to evaluate how much care actually costs and assess its quality.

The Centers for Medicare and Medicaid Services (CMS) and other federal agencies and advisory groups are currently soliciting feedback as they design regulations that will define how providers will be paid under this new approach. “This new system only works if it succeeds here in Maine,” Mitchell noted. “This is the time to engage as a community and make sure policy-makers have the information they need from real life practices to make these policy decisions.”

As currently envisioned, the MACRA legislation would essentially freeze Medicare and Medicaid reimbursement rates for the next several years and introduce a “merit-based incentive payment system” (MIPS) in 2019 that would reward physician groups that provided high-quality and cost-effective care. Bonuses would be awarded to successful providers, but those funds would come from “under-performer” penalties imposed on practices that do not meet the new merit-based criteria.

While Maine has led the nation in creating innovative programs that already evaluate a physician’s performance based on costs and patient satisfaction, physicians who listened to Mitchell’s talk were concerned their care would be considered over-priced by MACRA standards because they serve a large percentage of elderly patients with high-cost healthcare needs, compared to states with younger demographics.

Others were concerned that while they performed well individually, they may not score as well if performance was based on a group practice level instead of being linked to individual providers.

Mitchell explained that MACRA’s new measurements would include many criteria and could accommodate patient age and other factors. Efficiencies that would be rewarded includes patient satisfaction and innovative care approaches that could incorporate expanded home care for the elderly and prevention programs.

“These regulations are being drawn up now,” she reminded the providers, “everyone is at the table, this is time to speak up and express your concerns.”