From Bundled Payment Reform to MACRA: Pick Your Poison

Original story posted on: October 2, 2017
MACRA continues to be a subject that perplexes providers even as the program evolves.

It has been recently confirmed that the Comprehensive Care for Joint Replacement (CJR) bundled payment has been cut from 67 to 34 percent in the program, and the carding rehabilitation incentive with bundled payments has been cancelled. The new political leadership in Washington, D.C. continues to question the former initiatives and their value. Without question, the fee-for-service model will be replaced, but who can keep up with the constant changes and mandates?

It has been noted that 80 percent of providers plan to report on the Medicare Access and Chip Reauthorization Act of 2015 (MACRA) and Merit-Based Incentive Payment System (MIPS) programs, but 75 percent have indicated that they still do not understand the rules, which are outlined in hundreds of pages. Another challenge is that up until now, there were no exclusions if you were a one-person practice; the rules were the same as if you were an 1,800-provider practice. Recent announcements by the Centers for Medicare & Medicaid Services (CMS) have acknowledged this challenge, and the agency is adjusting the requirements.

How should you react to value-based care and invest seriously into this new notion? Providers have become complacent due to all of the background noise on this change

So what is the future for MACRA, MIPS, and Alternative Payment Models (APMs)? Is it any different? Like the Patient Protection and Affordable Care Act (PPACA) concerns in political circles, reformation is a concern, but it is a less punitive model being proposed?

Is it less burdensome so far? The answer is no.

As with bundled payments, it is reported that it costs three times as much to administer the new program than the traditional fee-for-service reimbursement program. Clinically speaking, information technology and its administration is overwhelming, and by no means offset fully by the financial rewards.

More than 70 percent of providers have said that MACRA does not support their “quality program,” and here is the reason why: it is not specific to specialty of care, the cost to adopt the program is significant, the rules are unclear, and there is no strong value proposition of the change to reimbursement at this time. As CMS begins to migrate to the new administration programs, it continues to adjust the MACRA requirements.

As this healthcare financial and clinical journey goes on, keep watch on the changes to the MACRA reporting requirements, the association with ACOs, and how providers embrace the changes.

Although MACRA has great benefits as compared with former programs, it continues to present great challenges.
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Lyman Sornberger, MBA

President and CEO for LGS Health Care and Chief Health Care Strategy Officer for Capio Partners. Prior to his roles at LGS Healthcare and Capio Partners, Sornberger was the Executive Director of Revenue Cycle Management for Cleveland Clinic Health Systems (CCHS) from 2006 – 2012. This role comprised of the Revenue Cycle Management for all 11 Cleveland Clinic Health Systems Ohio and Florida Hospitals and 1,800 Foundation Physicians. His responsibilities included all CCHS Patient Access Services, Health Information Management and Billing. Prior to his affiliation with CCHS Mr. Sornberger was with the University of Pittsburgh Medical Center for 22 years as a leader in revenue cycle management. Sornberger is a graduate from the University of Pittsburgh with a BS and Masters Degree in Business.

Related Stories

  • National Coding Contest Raises Serious Industry Questions
    Contest indicates coding accuracy is below expectations. Central Learning is a web-based coding assessment and education application. Since 2016, the company has conducted an annual national coding contest to measure ICD-10 coding accuracy and production. The initial premise was to…
  • UPMC versus Highmark – Can UPMC Pop Champagne Corks?
    The saga continues between UPMC hospitals and Highmark. UPMC reported revenue of $5.1 billion in the quarter ending March 31, 2019, up 10 percent from the $4.6 billion reported in the first quarter of last year. At the same time,…
  • CMS Proposed Rules Will Impact SNFs and Hospice Providers
    Proposed rules also include new payment models. The Centers for Medicare & Medicaid Services (CMS) has been quite busy these last few weeks issuing the proposed payment rules for 2020 and making some other announcements.  Here is an update on…