Three Key Things You Should Know About MACRA

By Elizabeth Mitchell, President and CEO, NRHI and Emily Dietsch, Senior Coordinator, Collaborative Learning Programs, NRHI

The final rules governing the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) will be released shortly by the Centers for Medicare & Medicaid Services (CMS). CMS is incorporating feedback from stakeholders on the proposed rules, for example: physicians will now be allowed to “pick their pace” of participation for the first performance period and have four options to avoid a negative payment adjustment.

What will not change is that regardless where you are on the stakeholder spectrum– provider, purchaser, plan, policymaker or patient – MACRA is likely to affect you. For example, in terms of Medicare Part B payments, practitioners will transition away from volume-based reimbursement to a new value-based system intended to improve care, enhance outcomes and reduce costs. When it comes to Medicaid’s importance – and its ubiquity – MACRA’s impact is likely to affect all payments over time, as practices gear up for the most significant reimbursement transformation in decades.

As many stakeholders are still developing a foundational understanding of the scope of the bill, here are three key points to consider:

  1. Why is everyone talking about MACRA? From a policy perspective, MACRA is the proverbial elephant in the room. Even in the run-up to implementation, it’s a subject that’s difficult to avoid in healthcare. Because MACRA affects both the way care is delivered, and the way physicians are compensated for that care, its impact is likely to be more significant that the Affordable Care Act (ACA), which focused largely on insurance. Because MACRA was passed with wide bi-partisan support, it is very likely to be with us for the foreseeable future regardless of a change in administration. In addition, as its changes will affect all stakeholders in the healthcare spectrum its impact is likely to grow over time.
  2. Who will MACRA affect? In short, MACRA will affect everyone. In the short term, its impact will be most pronounced on physicians who participate in Medicare. As the rules go into effect, and practices adapt to new quality-based payment models, MACRA’s impact will expand, ultimately driving market shifts that go beyond Medicare Part B. CMS is currently actively seeking alignment with private commercial payers, and as they shift to alternative payment models, the commercial market is likely to follow suit.
  3. What should people consider as they anticipate MACRA implementation? It’s important to consider all the elements of the new law. While MACRA’s primary impact will be on payment, its impact will change:
    • How healthcare data is shared, establishing new standards for interoperability to enable record transmission across providers, systems and communities;
    • The measures used to evaluate performance, transitioning away from volume to focus on care quality, outcomes and patient experience;
    • Availability of technical support, with significant federal resources allocated to help providers in their efforts to succeed in the new value-based environment.

The new MACRA rules are scheduled to go into effect January 1, 2017, regardless of where we all are in terms of preparedness and implementation. There are a few things you can do to make sure you are ready:

  1. Educate yourself by learning as much as you can about MACRA
  2. Engage fellow providers and practice staff so everyone is on board with the process
  3. Understand your current reporting and your data

We hope you will look to NRHI for continually updated information and best practice sharing as MACRA rules are refined and implemented. MACRA has the potential to catalyze major system transformation as the largest healthcare purchaser in the world changes course, but the success of this policy change will depend on local implementation.


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