The Financial Impact of MACRA


MACRA will adjust the fee schedule for all providers upward by 0.5 percent annually from now through 2019. It’s been said that Physicians who are aligned with APM will assume a certain amount of unavoidable risk. Hence, to encourage participation, the APM track will provide 5 percent bonus payments every year from 2019 to 2024 to all newly joining providers. Physicians under this bonus payment structure will only need to adhere to the quality reporting requirements of the APM and will be exempt from the MIPS quality program.

It’s a bit of a challenge to navigate the impact and outcomes of MACRA on the finances of healthcare organizations and that’s an understatement. How will large integrated healthcare delivery networks predict the impact of a new healthcare law on the system and how will it change Medicare reimbursement? To answer this question requires a comprehensive understanding of the impact of Medicare Access and CHIP Reauthorization Act (MACRA) final rule.

Health Catalyst lists 5 key points that demand attention when dealing with the financial impactS of MACRA. These key points are:

  1. Smaller practices will feel the biggest pinch.
  2. Issues such as care coordination and shared decision-making will need to be worked into the normal practice workflow in order to fully benefit from, or at least not get penalized under, MACRA.
  3. Meaningful Use (MU) will not disappear but will morph into a different program encompassed by MIPS.
  4. MACRA will impact not only physicians and traditional primary care providers, such as nurse practitioners and physician assistants, but others, including physical therapists, nurse midwives, and clinical psychologists.
  5. Preparation will be paramount.

How can healthcare organizations and health practitioners prepare for the financial impact of MACRA? Considering the many variations and complexities it’s going to take a lot to prepare but a first step is understanding the impact of these changes in order to make proactive moves

Possible Impacts of MACRA

  • MACRA intends to merge existing value-based payment methodologies into a two-track system for processing physician payments. This new two-track system will be based more on value and less on volume i.e quality over quantity. MACRA will require physicians, clinician groups, and health organizations to understand and implement this incredibly complex payment system. This will be confusing initially but health providers can prepare by being fully immersed in the rules and understand them, apply all measures and rules that are new, and track their performance based on MACRA assigned measures.
  • MACRA will require physician groups to educate providers, gather and analyze data and report measures.  These MACRA rules are about 980 pages of incredibly complicated rules, explanations, and formulas. It’ll take a lot of time and more than a few people to fully analyze and understand all the rules contained in whopping 980 pages. It’s going to be almost impossible to not miss something. In addition, some of the rules have not been finalized such as how the rules will apply to hospital-based physicians there leaving room for my changes and the possibility of more pages being added to the already 980-page document.
  • MACRA will link reimbursement to an outcome with the aim of improving cost control. This will put health providers under financial pressure when making decisions about the best treatment path to take for patients.
  • The MACRA options would allow a health provider to choose how they will be paid and the results will differ based on practices. Once a provider chooses a reimbursement model, price patterns will follow to maximize results and this might hinder the quality of healthcare provided to patients. It’ll also 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,