Glance Back to Move Forward and Get Ahead with MACRA Changes Afoot

History will doubtless record the collapse of healthcare’s traditional fee-for-service model. While the ransacking of fee-for-service has taken longer than Visigoth King Alaric’s three-day siege and sack of Rome in 410 AD, both the medical community and the Romans should have seen it coming. After all, when Alaric breached the city gate it was his third siege in as many years. As for the healthcare industry, it began marching inexorably toward value-based reimbursement (VBR) with the advent of Medicare’s Professional Standards Review Organizations in 1972.

This reimbursement evolution has caught most healthcare organizations unprepared – even as history writes the fee-for-service obituary. Medical groups paying attention understand that actionable data (both quality and financial), which can only be gathered from an EHR set up to collect that data, will have a HUGE impact on an organization’s ability to weather the vanguard. Actually, there are only a handful of health tech companies that sent out early scouting parties and that have already retooled their EHR to be a partner and not a hindrance.

The truth is, ICD-10, Meaningful Use, EHR incentive programs, and PQRS have all acted as expeditionary forces for alternate payment models (APMs). But unlike ICD-10’s myriad stops, starts, and delays, APMs are storming the gates. CMS is actually ahead of its stated 30% fee-for-service replacement goal for the end of 2016. They’re highly motivated to get this done in short order because if they know one thing, it’s this – they will save even more money than forecast because most healthcare providers will ignore the warning flares and delay adopting the right technology and tools until change is forced upon them. And by then, it’s too late. Too late to make the necessary modifications to care delivery. Too late to collect the required history of data. Too late to change treatment protocols to a “less is more” focus. Too late to call in the cavalry.

Some may think, “No big deal…. I’ll just read the new regs and figure it out.” Have they actually read the CMS guidelines for all the new acronym models? We’re talking about MACRA, MIPS, and other APMs streaming into the system. Trying to understand EXACTLY how to prepare gets lost in the fog of trying to understand EXACTLY what in the heck these models are.

After five years on the march (and on the road) rallying forces behind the idea that ICD-10 is critical to the future of medical groups, we’ve come full circle. When I spoke about ICD-10 as a harbinger for ACOs and value-based reimbursement, folks looked at me as though I had two heads. Now even a quick glance at Twitter or LinkedIn reveals a plethora of articles about VBR models.

The coming series of articles will deliver valuable information concisely and – fingers crossed – engagingly. We’ll start with background information about MARCA and MIPS, and then move into defining the different types of APMs. You’ll learn about payer movement towards APMs and what medical groups are doing right now. Most importantly, we’ll discuss which industries are ready to deliver good data that will position you to receive high reimbursements. Finally, you’ll receive solid advice about how to prepare your group to succeed within these new payment models.

In the meantime, consider the words of Henry Wadsworth Longfellow, who wrote, “All things must change; to something new, to something strange.” Change is the one true constant in the healthcare industry. Benefitting from that change requires clear-eyed awareness of the challenges that lay ahead – and turning the tables on the Visigoths at the gate.