Republican efforts to repeal the Affordable Care Act and replace it with a more GOP-friendly approach to healthcare reform have been tabled for now. While a “revive and repeal” movement is already in the works, the delay could play in favor of another piece of landmark healthcare legislation.
The Medicare Access and CHIP Reauthorization Act, or MACRA, took effect at the beginning of 2017 and established financial bonuses and penalties for qualifying physicians and healthcare organizations depending on how along they are in moving from volume- to value-based care. Despite the enormous financial implications on the line with MACRA, many providers have been left in the dark on how exactly to comply with the law. In fact, a survey released by Stoltenberg Consulting in March stated almost 64 percent of providers felt they were unprepared for MACRA; not a good sign considering they are already three months in to its taking effect.
The list of problems surrounding MACRA’s implementation is long and includes providers who are exempt from the program not being notified of their exemption, ambiguity over which electronic health records vendors are eligible for participation, and a general lack of details on exactly how providers and their partners are to report performance to CMS. In essence, who should report, how to report, and what should be reported is all murky to providers on an issue that stands to significantly impact how much money is in their pocket at the end of the day.
The best case scenario is CMS, in a brief respite from the battle over America’s next healthcare bill, will release the needed information to providers and provide assistance where needed to get implementation moving along. Even if CMS moves quickly, the damage may already be done for MACRA to be successful in 2017 and to transition to the full program at the beginning of 2018. As in most healthcare related ventures change takes time, and the technology requirements for MACRA are more than ever before.
Once providers know the full details, they will need to carefully choose the EHR platform and metrics best suited for allowing them to report successfully for the program. Next, trials and testing will be required to make sure everything is running smoothly before organizations take the leap into actually reporting on the program. With MACRA already live, there might not be enough time for providers to successfully report in 2017, a year that is already in “MACRA-lite” mode after CMS offered multiple options to acclimate providers to the program while lowering potential penalties.
While the tabled American Health Care Act and MACRA are two different pieces of legislation, they are intrinsically connected: Both are aimed at moving U.S. healthcare toward quality and value, and both require government support to be successful. With the AHCA out of the limelight for now, there is hope that the resources and guidance needed to push MACRA along will be forthcoming. However, the delay in release of details most likely signals another pushback of the full MACRA program into at least mid-2018 and possibly 2019.
The delay is necessitated by the EHR technology investment (money, hardware, and software) required for MACRA, and CMS owes providers and healthcare organizations adequate time and resources for them to flourish.
Evan Camden is an associate analyst at DRG and an expert on electronic health records. Follow him on Twitter at @EvanCamdenDRG.