2. MACRA will require physician groups to spend a tremendous amount of resources to educate providers, gather/analyze data, and report measures.
"The proposed MACRA rules are more than 960 pages of incredibly complex and dense details, formulas and explanations. It will take a cadre of experts to simply explain the basics to most of us in healthcare today," Pao says. "There are also many unknowns. For example, our organization, [CEP America], partners with physicians to provide acute care in hospital, ER, urgent care and other practice settings. It has not yet been finalized how some of the MACRA rules will apply to hospital-based physicians, leading to additional uncertainties."
3. MACRA does offer the opportunity for physicians to design alternative payment models (APMs), but the requirements for qualifying for advanced APMs are challenging.
"One of the more rigorous requirements to qualify as an advanced APM is that a provider or group must meet certain revenue thresholds," Pao explains. "Eventually, providers must receive at least 75% of Medicare Part B payments through an advanced alternative payment model in order to qualify for bonus payments. When combined with a risk-sharing mandate, meeting the requirements for an advanced alternative payment model will be difficult for smaller provider groups and certain specialties. Larger physician groups will have more resources to work under MACRA, but even so, adapting is going to take considerable time, resources and brain trusts."
4. Providers are going to be under financial pressures when making daily decisions about what is best for their patients.
"MACRA leaves all reporting in the hands of the provider with the goal of improving cost control by linking reimbursement to outcomes," says David Reid, employee insurance veteran and founder and CEO, EaseCentral. "Medicare beneficiaries should be very concerned."
5. The MACRA options allow a provider to choose how they will be paid and the results will differ based on practices. "Care received by a patient will likely be different based on the method adopted by the provider. Once a provider chooses a reimbursement model, price patterns will follow to maximize results. How is that best for the consumer?," Reid asks.
6. It will be easier for large practice groups to manipulate reimbursement levels based on self-reported actions and outcomes so complex it will be difficult to determine if patient outcomes were top concern, according to Reid.
7. MACRA will try to improve the relevancy of Medicare’s value and allow clinician flexibility to choose measures and activities appropriate to the type of care they provide, according to Ann Kuenker, DO, who has a wellness and prevention practice in Traverse City, Michigan, and serves on the Ideal Protein Inaugural Medical Advisory Board.