What exactly is MACRA?

[Warderino92]

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I keep hearing people talking about this and I tried to look it up and it looked like a bunch of policy crap i'm not at a level to understand yet. Can anyone break it down for what it'll mean for us as a profession going forward?

 

[673441]

Something about being paid for quality of care or something...


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[SurfingDoctor]

https://qpp.cms.gov/

Essentially, it is Medicare and Mediacid reimbursement based on outcomes. If your outcomes are good, you get a positive % adjustment on reimbursement (bang for the bang). If your outcomes are poor, you get a negative % adjustment on reimbursement (ie, the provider is wasting dollars without an improvement theoretically). Its meant to create an incentive to providers to spend less and improve outcomes/quality... who knows if it will do that though.

 

[Warderino92]

https://qpp.cms.gov/

Essentially, it is Medicare and Mediacid reimbursement based on outcomes. If your outcomes are good, you get a positive % adjustment on reimbursement (bang for the bang). If your outcomes are poor, you get a negative % adjustment on reimbursement (ie, the provider is wasting dollars without an improvement theoretically). Its meant to create an incentive to providers to spend less and improve outcomes/quality... who knows if it will do that though.

Would this lead to some physicians gaming the system by pushing out or not accepting patients that have multiple chronic diseases and thus would have worse outcomes and more repeat visits?

 

[SurfingDoctor]

Would this lead to some physicians gaming the system by pushing out or not accepting patients that have multiple chronic diseases and thus would have worse outcomes and more repeat visits?

I don't know. You usually have to be over 65, have a severe disability or end stage kidney disease, so Medicare doesn't really support people with good health or good expected outcomes to begin with. I suppose someone could cherry pick patients to have better outcomes, however the outcomes incentives are based on current health. All that being said, people already game the system. It's called Medicare fraud, and its more common than one would think. I suppose the MACRA is designed to reduce some of that as one is not rewarded for ordering unnecessary and can only get additional reimbursement for demonstrating good outcomes, but if there is a way to game the system, someone will find a way. But that isn't different from the current system.

 

[cbrons]

Was going to make a thread about this very thing today. I watched a YouTube video about it. Still have absolutely no clue what it is. Experience has taught me that when you don't understand a new and highly touted government policy, you can be 100% sure you're getting screwed.

 

[cbrons]

Something about being paid for quality of care or something...

Whatever that means. If it's determined by a non-physician bureaucrat, the meaning of "quality" can be quite nebulous indeed.

 

[boshtrich]

Whatever that means. If it's determined by a non-physician bureaucrat, the meaning of "quality" can be quite nebulous indeed.

And guaranteed to be full of "quality metrics" as determined by lawyers and accountants.

 

[673441]

Would this lead to some physicians gaming the system by pushing out or not accepting patients that have multiple chronic diseases and thus would have worse outcomes and more repeat visits?

This was exactly what I thought too... if patients are non-compliant or not serious about their care then they will have a really difficult time getting any care at all!


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