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Thread: Upload your presentation and answer the following prompt: Do you believe MACRAshould be renewed based on your analysis? Please include two of the scholarly references youused in your project and a biblical integration. MACRA ANALYSIS AND
PRESENTATION
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Background, Original Intent, How It Changed The Healthcare Landscape
The Medicare Access and CHIP Reauthorization Act (MACRA) was passed on a bipartisan
terms on April 16, 2015 to replace the sustainable growth rate (SGR) with the two-track
Quality Payment Program (QPP). QPP entails Merit-Based Incentive Payments System (MIPS)
which streamlines the multiple quality programs and Medicare payment system (Dalsing,
2019).
MACRA also intended to provide bonus payment for participation in eligible alternative
models and remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.
Through MACRA, clinicians can choose to either limit the number of fee-for-service
beneficiaries and replaced with commercial or Medicare patients. MACRA also affected
Medicare payers by disrupting the program’s supplement market. The removal of new Plan F
enrolments limits the scope of care access. Plan F has been the most comprehensive of the 10
Medicare coverage plans (Cheng et al., 2020)
Summary of the MACRA framework
Source: Center for Medicare and Medicaid Services:
https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/22QPP_FinalRuleSummary.pdf
Industry Response to MACRA
Federation of American Hospitals (FAH) praised MACRA for its emphasis on care value as opposed to performance. The
American Medical Association (AMA) praised MACRA’s framework but highlighted the need for a simpler structure that
encourages participation in Advanced APMs (Lyell et al., 2018).
The American Hospital Association lauded the extra flexibility that MACRA offers hospital-based doctors, but advocated for
more meaningful use criteria for hospital EHRs. The Utilization Review Accreditation Commission underscored the
importance of its slow implementation, but advocated for further strategies for improving the program to become an ideal
value-based reimbursement system (Lyell et al., 2018).
The American Medical Group Association (AMGA) opposed the program’s slow implementation due to its negative effects
on advances towards value-based system. Health Affairs Forefront criticized MACRA’s reliance on an inadequate feedback
loop, dependence on unreliable quality store, and tendency of rewarding reporting capabilities over professional excellence
(Lyell et al., 2018). A section of researchers also criticized the program for its negative impacts on clinician earnings.
Has it been well received? Has it improved
physician burnout rates?
Various healthcare stakeholders have reacted differently to MACRA. The AMA and AHA support it while AMGA
and other rejected most of its premises.
Despite drawing on research that suggests changing physician payment methods can lower physician burnout rates,
MACRA has failed to deescalate physician burnout rates (Khullar et al., 2021).
Since the passing of MACRA, physician burnout rates nationwide have significantly increased. Average burnout rates
increased from 31% to 38% between 2015 and 2020, according to some estimates, while other sources claimed they
had reached close to 68% (Khullar et al., 2021).
This suggests that the MACRA has not addressed physician burnout rates, but other variables, such the COVID-19
epidemic, have contributed to these increases.
Changes in Healthcare Costs Over The Last 10 Years
The Centers for Medicare and Medicaid Services’ data on health spending shows that healthcare expenses have usually
increased over the last ten years, peaking between 2020 and 2022 (CMMS, 2022).
However, between 2016 and 2019, healthcare costs rose. The total cost of healthcare increased 14% from $2.91 trillion
in 2012 to $3.34 trillion in 2016.
According to 2019 figures, total healthcare spending hit $3.65 trillion, up 9.28% from 2016. Between 2019 and 2022,
healthcare spending fell to $4.4 trillion, a 20.55% increase (CMMS, 2022).
In addition to the pandemic, this decline may also be attributed to a decline in medical care utilization and a decline in
public health expenditures.
MACRA’s influence on costs and the
biggest driver of cost
There have been decreases in the cost of healthcare for Medicare buyer over the last 10
years, mainly driven by reduced total deductibles for Medicare payment.
Recent PADSIM assessments show that more clinicians have shifted into alternative
payment methods, leading to a $32 billion increase in total payment to hospitals (to
$250 billion yearly) (CMS, 2022).
There have been lower Medicare payments which have reduced spending on services
from $141 billion to $106 billion between 2015 and 2019 (CMMS, 2022)..
Latest analyses project that MACRA could positively influence physician revenue to
grow from $81 billion in 2014 to $109 billion in 2030 (CMMS, 2022).
Impact of MACRA on healthcare quality
MACRA has improved healthcare quality for Medicare buyers in several ways, albeit with specific challenges.
With over 1 million doctors (roughly 95% of those eligible) enrolled in MIPS and 99,000 others qualified for AAPM enrolled,
MACRA placed Medicare buyers at a better position to access and utilize personalized care from professional clinicians.
Another 73,600 doctors were qualified to join the Next Generation accountable care organization initiative (McWilliams,
2017).
Aside from progressing towards addressing payment issues related to Medicare clinicians, MACRA has also drastically
improved patient outcomes and lower the cost of healthcare at the buyer level.
However, despite quality improvements in care delivery, and streamlined payment models, payment streams are more
concentrated in MIPS organization, leading to high running costs of the program (CMS, 2022). MACRA has failed to meet its
core functions at assigned costs, thus a waste of taxpayer funds (McWilliams, 2017).
Does the United States have better access to better
care now than we did before?
The United States does not have a better access to healthcare now than before. After MACRA, healthcare access
improved, but it began to decline in the subsequent years rate than before.
According to statistics, the proportion of persons who had insurance increased from 84% in 2010 to 89.6.9% in 2014
and 90.9% in 2015. With the adoption of MACRA in 2015, private health insurance remained more prevalent than
public coverage at 67.2 percent and 37.1%, respectively (CMMS, 2022).
88.1% of people in 2021 have regular places to go for medical care. However, the overall percentage of Americans with
health insurance coverage dropped to 89.7%, leaving more than 33.2 million people of all ages without coverage
(CMMS, 2022). In 2022, 6.1% of adults have failed to obtain coverage subscriptions due to cost-related reasons.
Should We Renew MACRA?
The renewal of MACRA is a hotly contested issue. However, I think that the program should
be renewed, but its framework reviewed to better serve Medicare buyers.
MACRA is properly addressing payment challenges for Medicare clinicians, albeit in a
slower-than-expected manner.
The large number of participants that the program has attracted through MIPS should be
retained while more enrollees should be attracted into ACOs.
Issues surrounding performance measurement, cost effectiveness, and reliability of feedback
channels should be addressed to improve program efficiency.
References
The Centers for Medicare and Medicaid Services (CMS), (2022). 2022 Quality Payment Program Final Rule. Arlington, VA:
CMS. https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/22QPP_FinalRuleSummary.pdf
Cheng, J., Kim, J., Bieber, S. D., & Lin, E. (2020). Four Years into MACRA: What has Changed? Seminars in Dialysis,
33(1), 26–34. https://doi.org/10.1111%2Fsdi.12852
Dalsing, M. C. (2019). The five things we all need to know about MACRA and alternative payment systems to compete and
flourish. Journal of Vascular Surgery, 67(3), 970-973. https://doi.org/10.1016/j.jvs.2017.09.012
Jones, R. T., Helm, B., & Parris, D. (2019). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Made
Simple for Medical and Radiation Oncologists: A Narrative Review. JAMA Oncology, 5(5), 723-727.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2718414
Lyell, K., Jones, J. M., Becker, A., Kaloides, A., & Eugene Scharf. (2018). MACRA and the future of value-based care.
Neurology Clinical Practice, 6(5), 459–465. https://doi.org/10.1212%2FCPJ.0000000000000296
McWilliams, J. M. (2017). MACRA — Big Fix or Big Problem? Annals of Internal Medicine, 167(2), 122–124.
https://doi.org/10.7326%2FM17-0230
Khullar, D., Bond, A.M., Qian, Y., O’Donnell, Y., Gans, D.N, & Casalino, L.P., (2021). Physician Practice Leaders’
Perceptions of Medicare’s Merit-Based Incentive Payment System (MIPS). Journal of General Internal Medicine, 36(12),
3752–3758. https://doi.org/10.1007%2Fs11606-021-06758-w
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