Reimbursement from insurers is a major concern for those who work in the healthcare system. Because few patients pay out-of-pocket for services, much of the revenue of medical providers and organizations alike depends on payouts from both private and public insurers. One of the largest contributors to these payments is the federal health insurance program Medicare.
In October 2016, the Department of Health & Human Services (HHS) finalized the new Medicare payment system known as MACRA – or more formally, the Medicare Access and CHIP Reauthorization Act of 2015. The move, which is being touted as a “landmark new payment system” by HHS, was the result of months of revisions and will significantly affect how healthcare is reimbursed by the federal program in 2017.
What is MACRA?
MACRA was created in 2015 to form a new payment plan for providers who treat patients covered by Medicare. Through the initial outline and subsequent revisions, HHS crafted an incentive program based on merit that rewards healthcare organizations and staff members for providing quality care to patients, as opposed to simply providing as much treatment as possible. It is part of a larger move toward value-based care that has been playing an influential role in most every component of the medical field over the past several years. MACRA is the largest reform of the healthcare system since the 2010 Patient Protection and Affordable Care Act, more commonly known as Obamacare.
In a press release on October 14, 2016, HHS announced that the new system for Medicare clinicians had been finalized.
“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” HHS Secretary Sylvia M. Burwell said in the statement. “Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our healthcare system for patients, clinicians and the American taxpayer.”
The new Quality Payment Program replaces the old Sustainable Growth Rate model, creating a major shift toward reimbursing for quality, rather than quantity, in healthcare. HHS believes that this new system will give providers and healthcare organizations the tools that they need to provide high-quality, individual care to patients.
The organization also believes that the plan is a wiser use of taxpayers’ dollars, as Medicare is paying for what works in terms of patient care. It could also save money through the fact that it encourages prevention and wellness among patients, rather than simply rewarding providers for responding to problems as they arise. This new strategy is believed to be more cost-effective in the long run.
Changes in 2017
Though initially introduced in 2015, MACRA was not finalized until the end of 2016 to allow for alterations based on input from clinicians and healthcare organizations from across the country. According to the press release, many of these changes are meant to provide simplicity, flexibility and support, specifically for small practices. The need for these alterations was a common theme in the feedback that was received by HHS.
The new rule went into effect on Jan. 1, 2017, but HHS has announced multiple flexibilities that will allow providers and organizations to rule into the new system.
“It’s time to modernize the Medicare physician payment system to be more streamlined and effective at supporting high-quality patient care. To be successful, we must put patients and clinicians at the center of the Quality Payment Program,” Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS) said in the statement. “A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose. Today’s policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures.”
However, not everyone is confident in this switch, even with the revisions made in the finalized rule. According to an Advisory Board survey of 30 employed medical groups, 70 percent of respondents are worried about the implementation of MACRA. Of the remaining 30 percent, only 20 percent were confident about the implementation and 10 percent were ambivalent.
For better or for worse, MACRA, complete with these additional changes, has gone into effect and it now remains to be seen how the transition period goes for providers and the organizations for which they work.
The importance of health informatics
Health informatics is an important part of ensuring providers and healthcare organizations remain compliant to MACRA. The more information that is collected, the better chance there is that the full reimbursement will be paid out. Furthermore, under MACRA, there is federal push to ensure implementation of electronic health records nationwide by the end of 2018. Because professionals who work in health informatics play a crucial role in ensuring that all of this data is gathered, stored and reported properly, it is no surprise that the Bureau of Labor Statistics projected that demand for Medical Records and Health Information Technicians will increase by 15 percent between 2014 and 2024, adding approximately 29,000 new jobs to the market.
To be a part of this quickly-growing field that is positively affecting patient care and outcomes, consider pursuing an online master’s degree in Health Informatics through the University of Illinois at Chicago. In the convenient online format, you will be able to complete your degree in as little as two years, while having the flexibility to continue to simultaneously work in the field of your choosing.