What is MACRA?


Despite being called the most significant healthcare legislation since — no, not the Affordable Care Act — but since Medicare was enacted in 1965, MACRA has been predicted by most to survive the wildfires burning across the federal government’s healthcare policy today. However, the legislation is making a slower entry than planned under the Obama Administration, with CMS’s recent proposed rule for the  2018 Quality Payment Program leaving many to wonder whether the push to value-based care will continue or stagnate.

The Quality Payment Program is CMS’s name for the policies resulting from MACRA. MACRA, or the Medicare Access and CHIP Reauthorization Act, was bipartisan legislation signed into law in late 2017. In short, it is an overhaul of how the federal government pays providers who serve Medicare patients, involving a plethora of quality measurements that providers have leeway to choose between and that their payments are tied to. For the first time, it requires Medicare Part B payments for a large number of providers to be tied to quality.

Changes in the Proposed Rule

There are a few key changes in the proposed rule that stakeholders are invited to weigh in on. Most notably, the threshold of how much of a provider’s’ revenue must be Medicare Part B revenues increased from $30,000 annually to $90,000. This change means more clinicians will be exempted from the program than before, easing the administrative burden for those clinicians, but it is not clear whether this will have a major impact on everyone else or on the momentum behind the pay-for-value movement.

So why is MACRA so significant?

Providers are already strained with nearly a third of hospitals in the red each year and operating margins hovering under 3%. The more pressure these stakeholders are under financially, the more they will be looking for innovative contracting opportunities to reduce their risk.

The Brooks Group Primer: MACRA

To gain deep knowledge on these trends and more, access the Brooks Group Primer on MACRA. This resource offers deep insights into:

  • the effects and impacts of MACRA on payments,
  • the two reimbursement structures,
  • the quality measures that are involved, and
  • the impacts of MACRA on both providers and pharma.

Learn more at https://thebrooksgrouponline.com/healthcare-primers/ and contact Peter Haines at peter.haines@thebrooksgrouponline.com for more.

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