The MACRA Effect: Healthcare’s Digital Age in the Trump Era


While newly installed President Donald Trump and a Republican-controlled U.S. Congress focus on repealing the Affordable Care Act and appointing like-minded leaders for prominent healthcare policy positions, another piece of landmark healthcare legislation is poised to forge ahead uninhibited.

The Medicare Access and CHIP Reauthorization Act, better known as MACRA, rolled out last month, just as the Trump administration took power. Like the ACA, MACRA is aimed at shifting Medicare care delivery and reimbursement toward quality and value. But unlike the embattled ACA, MACRA has enjoyed strong bipartisan support, passing the House of Representatives last spring in a 392-37 vote and the Senate in a 92-8 vote. To be sure, the coast isn’t entirely clear—Health and Human Services Secretary nominee Tom Price has expressed reservations about certain portions of the law—but all political signs point to MACRA staying the course.

A key driver pushing the U.S. healthcare market from fee-for-service to fee-for-value is the adoption of new technology, with electronic health records at the helm. The government has always been influential in reform as EHRs’ rise to prominence began with Recovery and Reinvestment Act in 2009, followed by Meaningful Use in 2011, and now MACRA, as each piece of legislation focused more on specific metrics and capabilities designed to improved patient care and efficiency. While previous acts usually utilized bonuses and possible extra payments as incentives to participate, MACRA is a new beast, as it will be mandatory for any acute-care hospital being reimbursed through Medicare.

MACRA will streamline multiple previous quality programs under the Merit-Based Incentive Payments System (MIPS) and the Advanced Alternative Payment Models (APM) program, yet will also impact Medicare Reimbursement by plus or minus 4 percent beginning in 2019 and up to 9 percent by 2022. With so much riding on success with MACRA, the government has pushed health systems and their technological capabilities into new territory, effectively forcing healthcare to evolve.

While MACRA will likely continue to move forward, the exact ramifications of the law will be unknown until the program is seen in action. What we do know is EHRs have played a pivotal role thus far in the evolution of healthcare, and will continue to do so through MACRA and into the future.

For a more complete history and analysis of EHRs in healthcare reform, as well as possible effects of MACRA moving forward, click here to download the Executive Briefing, “EHRs in the Age of MACRA: The New Constant in an Ever-Changing Healthcare Payment Equation.”

Evan Camden is an associate analyst at DRG and an expert on electronic health records. Follow him on Twitter at @EvanCamdenDRG.