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MACRA White Paper: How the Rules for Medicare Physician Reimbursement Are Changing

MACRA White Paper: How the Rules for Medicare Physician Reimbursement Are Changing

Since the passage of the Medicare Access and CHIP Reauthorization Act of 2015 — a.k.a., MACRA — the process of Medicare physician reimbursement has been incrementally changing towards a new performance-based compensation model. The new rules are already partially in effect; a full implementation is scheduled for January, 2019.

Yet despite the fact that it's already been set in motion, many physicians are still in the dark about MACRA. Survey after survey shows that a significant portion of doctors are, at best, reluctant to participate in, and at worst, completely in the dark about the new physician reimbursement rules.

Less than a year ago, a physician survey showed that only 20% of doctors were actually familiar with MACRA — and only 6% of the more than 17,000 surveyed physicians stating that they were very familiar with it. By contrast, one-third of those surveyed defined themselves as "very unfamiliar" with the new Medicare reimbursement rules.

Some may speculate that many of the physicians who remain ignorant of MACRA do so because they don't particularly want to have to know anything about how Medicare reimbursement works. For hospital-employed physicians and clinicians, or those who work with a locum tenens firm like Staff Care, the ideal career involves one in which those kinds of administrative tasks are someone else's responsibility.

Indeed, it often is the responsibility of the healthcare employer to prepare against MACRA, whether or not that involves also bringing your doctors and clinicians on board, too. With this in mind, the latest white paper from the Staff Care experts offers an overview of just what healthcare employers, managers and administrators should know about MACRA. Whether or not you're directly tasked with determining (and planning) Medicare reimbursement, this basic yet detailed guide works as not just a great primer but also an ongoing point of reference for you and your team.

Free MACRA White Paper

MACRA White Paper:
How the Rules for Medicare Physician Reimbursement Are Changing

The main element of the new Medicare reimbursement rules is the double-tiered payment model system, in which physicians are classified as either Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). MIPS, the more prevalent model, is based on a system of performance scoring divided into four categories: Quality, Improvement Activities, Advancing Care Information, and Cost.

MACRA: A New Medicare Reimbursement Method for Physicians: A White Paper from Staff Care"If physician scores are above the average, Medicare reimbursement rates will go up," the white paper authors note; "if at the average, there will be no adjustment, if below the average, Medicare payment will be cut."

The alternative payment models offer a means to avoid that system, with the price being the acceptance of "a lump sum of money to care for a certain group of patients." The idea is that physicians will be more "vigilant against wasteful care, since they will have a financial incentive to spend less than their lump sum amount," the authors note."

In addition to explaining the workings of these new payment models and scoring system, the white paper also unpacks what these new Medicare physician reimbursement rules are likely to mean to the nation's practices, hospitals and healthcare centers in the years and decades to come.

"The number of physicians hospitals employ is likely to further increase as the cost and complexity of complying with MIPS will cause more physicians to seek hospital employment or to join larger organizations of various kinds," the authors note.

"In the long-term, physicians are likely to seek participation in APMs, which also typically require employment by an ACO, hospital system or large medical group, leading to more declines in the number of private practice physicians."

If you represent a practice, hospital or healthcare center, we encourage you to take a few minutes to peruse our MACRA white paper — it's free, and available here. And if you're interested in discussing how Staff Care's physician recruitment services can help your organization weather MACRA and the changes it represents, you can contact us here, or submit a locums staffing request here.

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