Sunday, 19 August 2018

The Evolution of Healthcare: How to Prepare for MACRA

The healthcare industry has been going through many mini evolutions over the last couple of decades in part due to technological advances and new standards required by the government.  As such, there has been a lot of push and pull as to what to implement, when it should be in place or whether to hold off until those in authority make a more definite decision. 

However, with the implementation of the Affordable Care Act, the evolution has taken a more definitive direction and MACRA or Medicare Access and CHIP Reauthorization Act has been set up as the standard for all healthcare organizations to meet.  So, the question then is how to prepare for MACRA in your facilities.

It almost goes without saying that with government participation in how an industry is to be run, there is a lot of minutia that goes along with it.  I am not here to expound on the small details but to explain what is expected in the industry in the next few years.  Preparation will include understanding adherence issues and penalties that accompany noncompliance. 

On the surface, MACRA works to change the old way of being paid for every service provided, whether needed or not, and moves that to a performance-based payment or reimbursement program.  Fee-for-service wasn’t necessarily ripe for misuse; however, it didn’t promote patient health or experience and could exaggerate wasteful spending within the system. 



Progressing away from quantity toward quality sounds like it should be easy, but in a business as truly diverse as healthcare is, performance improvements are subjective and widely varied.  As part of the MACRA program, performance will be measured and weighed a little differently for each organization.

Overall Quality Improvements –  each organization will be able to choose for six different outcome measures to submit
Overall Expenses and Use of Resources –  a comparative look at cost to treat patients with similar ailments, illnesses or diseases against other organizations
Sharing of Care Information –  continuing efforts on data and healthcare information sharing to enable better and more secure healthcare treatment
Improvements to Clinical Activities –  encouragement for patient participation as well as family and other coordinated care efforts

You might recognize that these areas of focus are not set up as rigid standards that give an organization a pass or fail box to check, but take into consideration many different factors that lend themselves to interpretation and patient satisfaction levels, which were never really an element of good healthcare before. 



The single biggest feature in this evolution is data.  Data is what is going to indicate where problems lie, where waste is running rampant, where care is effective and where money is being spent.  One thing that the healthcare industry is producing in volumes is data, whether it be doctors’ notes, prescriptions, test results or imaging results. 

With all this data, and now the ability to decipher its underlying patterns, there is no excuse why an organization cannot benefit and be able to report all of its findings of the above-mentioned categories.  The largest roadblock that many executives face is that the information is siloed or located in different places behind different virtual walls.  MACRA may just help administrations to break down those walls and utilized data much more efficiently.

When facilities are willing to approach the question of how to prepare for MACRA with the inclination to see change as a good thing, goals and strategies can be established, and information can be distributed to all those that will be affected with the change.  The reason that this is such a big evolution has something to do with the fact that CMS (The Centers for Medicare and Medicaid Services) will be reducing the percentage they reimburse to hospitals and facilities for services provided.  Healthcare providers are expected to account for how their patient’s experience was, if a patient was readmitted to the hospital after being released and if costs were controlled better. 

One change that will bring about both an improvement to care and reduce the costs involved in changing from a fee-for-service payment method to a pay-for-performance process. The difference is very distinct in that the current fee-for-service approach is there is a payment charged for each service provided, such as a visit to the doctors, tests or any procedure. The payments are also seen as individual and paid separately. This is quite inefficient and requires more time and effort that needs to be applied. A move towards pay-for-performance would take into account services surrounding a patient and a situation, but also the satisfaction of the patient. The real incentive for care providers is that if they meet or exceed quality measures, financial bonuses are attached. There are some that aren’t convinced that change is necessary or warranted because the current system is working and the proposals don’t have enough evidence to show that they would improve the healthcare system or ACOs. Some individuals believe that some sort of hybrid system might be helpful and flexibility would be a better approach. A specific concern is that those organizations that don’t meet or exceed the new standards and practices would be called out publically and would thus lose trust and confidence of the public they serve.




Evolution doesn’t come about without significant changes and people being willing to support that change.  Patients and providers are looking for a path that helps offer better care while managing costs and this is exactly what the Medicare Access and CHIP Reauthorization Act will do.  Everyone can and will benefit from the transformation that is coming to healthcare, but healthcare organizations need to answer the fundamental question: how do we prepare for MACRA starting today?