There is an old Chinese curse that says: “May you live in interesting times.” From the first day in January, when the Medicare Access & CHIP Reauthorization Act (MACRA) took effect, to the final vote on the federal tax bill in the waning days of the year, 2017 has proven to be confusing and suspenseful – and interesting!
To round out the year, let’s take a look back at four of the most interesting developments of 2017!
1. MACRA, MIPS & APMS – Oh My!
The rollout of MACRA on January 1 sent providers, consultants and vendors scurrying to digest the 2,398-page MACRA rule. (Good news – it shrank to just 1,653 pages for 2018!) Physicians subject to the Merit-based Incentive Payment System (MIPS) have just days left to meet MACRA’s Quality Payment Program (QPP) reporting requirements to avoid a penalty in 2019. You only have to report quality information for one patient using just one measure, but you must do it in 2017.
Many providers were affected by natural disasters this year – including Hurricanes Harvey, Irma and Maria, and Northern California wildfires. They will get a break for 2017. CMS says they will be able to identify you and will automatically provide a neutral MIPS payment adjustment.
For everyone else, it’s time to take a deep breath and prepare for Year 2 of the program. While large practices and hospitals have probably already calculated the financial impact that the change of even a few percentage points will have on their bottom, it’s time for smaller practices to determine their potential long-term losses or gains.
2. Seeking to Dismantle the ACA
Just three weeks after MACRA debuted, President Donald Trump took the oath of office as the highest elected official in the country and repeated his campaign promise of dismantling the Affordable Care Act (ACA). The stop-and-go progress of various healthcare bills through Congress was reminiscent of the childhood game of “Stoplight” – advance, stop, go back.
In the end, the uncertainty in the marketplace drove many insurers away. For example, in metro Atlanta where Azalea’s headquarters are located and in Valdosta, where Azalea also has offices, those seeking insurance plans through the ACA marketplace had two choices, and both were limited in the health systems and physicians they include. This raises important questions for providers:
- How many of your current patients will change providers in order to be “in network?”
- If you are in network, are you prepared for an influx of new patients?
- What will be the financial impact of having more self-pay patients, especially since the new tax plan does away with the requirement for individuals to purchase health insurance?
- Will community hospitals and Federally Qualified Health Centers (FQHCs) now have a bigger burden of charity cases? Several hospitals in California are already approaching the new attorney general to relieve their charity-care obligations. (Modern Healthcare, December 18, 2017)