The Impact of the Medicare Access and CHIP Reauthorization Act (MACRA) on the Field of Ophthalmology
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To analyze the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on the field of ophthalmology.
DESIGN
A perspective on the effects of MACRA's Quality Payment Program after analysis of the proposed rule, final rule, and commentary submitted by relevant stakeholders.
RESULTS
Physicians will need to use one of two payment structures: Merit Based Incentive Payment Systems (MIPS), or Alternative Payment Models (APMs). APMs and MIPS will focus on bundling payments and reimbursing based on "fee-for-service-plus" models, which take into account clinical outcomes, coordination of care, clinical improvement and electronic information exchange and security. APMs have substantial advantages, with eligible participants receiving a bonus and a higher rate of annual adjustment over the program's life. For most ophthalmology practices, MIPS may be more appropriate due to its broader applicability and current paucity of APMs for ophthalmologists.
CONCLUSION
The Quality Payment Program is a substantial improvement over the negative adjustments under the repealed Substantial Growth Rate model. Ophthalmologists will likely utilize the MIPS system; however, its comparatively lower reimbursements, as well as its cost, quality, and other reporting measures may prove problematic.
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Additional Info
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The Impact of the Medicare Access and CHIP Reauthorization Act (MACRA) On the Field of Ophthalmology
Am J Ophthalmol 2017 Apr 13;[EPub Ahead of Print], B Kinker, K Dobesh, N Nassiri, MS Juzych, MR WilsonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This is important information to be aware of, to understand the rules and regulations that need to be followed, and how those will impact incentives or penalties. Importantly, these regulations can modify practice sizes and location, can modify the patient mix in a practice (to adjust for penalties), and may encourage more practitioners either to retire or simply not to participate in Medicare. Unfortunately, all of this can change unpredictably.
An interesting quote for me is, "One area of concern is that the use of cost measures could incentivize providers to use treatments that are lower-cost initially, but less cost-effective over the long-term. Because these long-term savings are not captured in the cost formula, total costs could actually rise. Early adopters of new technologies could also be unfairly penalized for their use, especially since long-term patient health outcomes will not be part of the physician’s reimbursement whereas yearly expenditures will be."
It sounds a lot like the focus on short-term goals that bedevil the practices of corporate America. This is an excellent article that needs to be digested slowly.
MACRA has joined third-party patient reimbursement models as one of the newest acronyms that has daunted physicians over the past few years. As a result of years of flawed Fee For Service Medicare payments through the sustainable growth factor, this legislation is the latest shift in attempting to try to get quality and value based medicine in reimbursement to providers with two potential reimbursement options: the Merit-based Incentive Payment system (MIPS) and the Alternate Payment Model (APM). Eye care providers are, for the most part, only going to be participating with MIPS as patient attribution to most APM’s will not be available to specialists. The premise that CMS takes is that MACRA allows doctors to be better by helping them focus on care quality and the one thing that matters most – making patients healthier. Unfortunately, from the author’s perspective the impact on eye care practitioners seems to be more gloomy than sunny. I believe the take-home message from this article might very well be that practitioners should consider the modes and methods of quality metrics for healthcare, as they are still evolving but definitely not unattainable.