MACRA, Medicare Access and CHIP Re-authorization ACT, was enacted in 2015 as a replacement for the Sustainable Growth Rate, SGR, for medical service payments. In 2016 changes were issued that substantially change the standards from Medicare reimbursements starting in 2017. This provides a short window for medical providers to learn about the details and implication of their practices as applied to MACRA.
How do these Changes affect you?
Up until these changes medical facilities have been subject to the performance based payment system of the Affordable Care ACT, ACA, with new changes medical providers will need to understand how to improve their performance to avoid payment penalties. This requires the development of complex governance models, adjusting data resources among all shared service providers and implementation of performance measurement resources.
- Medical facilities will need to readjust their service billing higher to meet new pricing models based on performance costs to meet the new policies.
- Different payment models often result in organization changes that affect service partners, products offered, and vendor relationships all of which change and limit patient options.
Medical professionals outsource compliance management and for some these new changes might be too much to manage alone. Physicians will join affiliate programs that are experts at managing compliance and changes in regulations. This will result in standardized services that will altogether eliminate or restrict access to services that don’t fit the new service models. Physicians that don’t participate in the new standards might move to early retirement rather than try to navigate the complex increasing changes on their own.
Product manufacturers are not excluded from the cost to performance guarantee. Through a Value based contracting agreement manufactures agree to liability for a portion of the products purchase price when the product fails to meet performance standards and in some cases pay penalties. This same practice, fairly common in medical facilities, is now becoming common with pharmaceuticals. Drug manufacturers are being forced to pay incentives or rebates when clinical test results don’t match up with distributed product patience results. Though keeping manufactures liable for the future performance of its product is an essential step in performance based services it’s one that will result in significant increase in product costs to the end user.
Navigating your insurance needs is an already complex endeavor. Do you know which plan best serves you in 2016 less what might serve you years from now? Access Health Insurance has been helping clients successfully navigate changes in Health Insurance for over 20 years. Contact Access Health Insurance today to make sure you and/or your company is on the right path in healthcare. www.accesshealthins.com