MACRA's a big deal for providers. But what does it mean for patients?

Topics: Federal Government, Care Models, Palliative Care, Patient Populations

By: Rachel Schulze, senior staff writer 

Most health care providers and policy wonks are familiar with the acronym MACRA–short for the Medicare Access and CHIP Reauthorization Act (PL 114-10). The bill, which was signed into law in April 2015, permanently repealed Medicare's Sustainable Growth Rate formula and called for value-based payment reforms.

CMS unveils proposed rule for value-based payment programs under MACRA >>>

However, the five-letter term likely is not at the forefront of the minds of one key group of health care stakeholders: patients.

At an Alliance for Health Reform briefing on Monday, experts explained what CMS' recently released proposed rule for MACRA could mean for patients—and how those regulations could be improved.

Implications for patients

At Monday's briefing, Stephanie Glover, a health policy analyst at the National Partnership for Women & Families, noted that consumers support shifting away from a fee-for-service system and toward value-based care. She called MACRA "an important first step in driving that needed health system transformation."

Specifically, CMS' proposed rule put forth the Quality Payment Program framework, which consists of two provider pathways:

  • Advanced Alternative Payment Models (APMs); and
  • The Merit-based Incentive Payment System (MIPS).

Glover noted that APMs hold potential to offer patient- and family-centered care that helps reduce costs. She said, "APMs should enable us to achieve all three tenets of the triple aim: better health outcomes, better experience of care, and lower costs."  

However, Glover stated that those aims will be achieved only "if [APMs] engage and meet the needs of patients they serve and improve how care is delivered." Glover noted that the Partnership in its comments recommended to CMS that Advanced APMs should be required to "demonstrate that their payment approach will reinforce patient and family-centered care with a strong primary care foundation."

Stakeholders raise common themes in MACRA comments >>>

Regarding high-value quality measures, Glover said that the Partnership in its comments urged CMS to improve consumers' ability to compare providers, such as by moving toward a "core set" of measures that include providers' specialty or subspecialty.

Glover also discussed the importance of adopting health IT that is beneficial to patients. She said that "MACRA should enhance patient and family caregivers' ability to access, contribute to, and use their own health information."

Lemeneh Tefera, a medical officer at CMS, noted that along with APMs, "just regular participation in the MIPS program is encouraging the use of electronic health records," and "there are multiple clinical practice group activities that focus on care coordination."

End-of-life care

In addition, panel members commented on what MACRA means for patients receiving end-of-life care.

Tonya Wells, vice president of public policy and federal advocacy at Trinity Health, said that incentivizing the use of APMs would be "very beneficial" to patients with chronic conditions and those seeking end-of-life care. She noted, "[T]o the extent that you're creating an accountability model where you're … really focusing on the patient in a more people-centered manner, and you're cognizant of the cost implications as well and the balance that all of that can create, I think really does result in a better outcome for those patients."

Tefera added that MACRA's emphasis on health IT use could bolster the end-of-life care patients receive. "[R]egarding end-of-life issues," he said that one of "the hardest challenges for clinicians … is seeing someone in dire straits and not knowing what you need to know about their past history." Tefera noted, "Downstream, the hopes of the MIPS program and certainly participating in [APMs] will hopefully improve the care plan provided."

Concerns for small, independent, and rural practices' patients

Also during Monday's briefing, Thomas Eppes, a Virginia-based family practice physician and member of the American Medical Association's (AMA) Integrated Physician Practice Section Governing Council, highlighted concerns that the proposed regulation would result in cuts for small, rural, and independent practices.

He said, "It's important that the rules … make sure that the new MIPS program doesn't hurt these physicians" because that "will hurt care of patients," adding, "Some of the most high-value care is delivered in these settings by small physicians, independent physicians."

Looking ahead

CMS is expected to release its final rule for MACRA in the fall. Although the final rule is still in the works, one thing is certain: Tefera noted, "The idea in principle of changing the existing fee-for-service landscape, it has a lot of support."