Policy/Regulation Fact Sheet

Policy/Regulation Selected: The Medicare Access and CHIP Reauthorization Act (MACRA)

Brief Explanation:

MACRA is a federal law that was passed in 2015. It aims to improve the quality and efficiency of healthcare by aligning financial incentives with value-based care. MACRA replaces the Medicare Sustainable Growth Rate (SGR) formula, which had been used to set Medicare physician reimbursement rates since 2002.

Under MACRA, physicians and other healthcare providers can participate in four different payment tracks:

• Merit-based incentive payment system (MIPS): This track is based on four performance categories: quality, improvement activities, cost, and advancing care information.
• Advanced alternative payment models (APMs): These models focus on coordinating care and improving quality outcomes.
• Traditional Medicare fee-for-service (FFS): This track is the traditional way that Medicare physicians are paid.
• Medicare Shared Savings Program (MSSP): This program is designed to encourage providers to coordinate care and improve quality outcomes while reducing costs.

Impact on System Implementation:

MACRA has had a significant impact on the implementation of health information technology (HIT) systems. In order to participate in the Merit-based incentive payment system (MIPS), providers must use certified electronic health record (EHR) systems and report quality data. This has led to an increase in the adoption of EHR systems by physicians and other healthcare providers.

MACRA has also encouraged the development of new HIT systems, such as clinical decision support systems (CDSS) and patient portals. CDSS systems can help providers to make better decisions about patient care, while patient portals can help patients to manage their own health.

Impact on Clinical Care, Patient/Provider Interactions, and Workflow:

MACRA has had a positive impact on clinical care, patient/provider interactions, and workflow in several ways. First, MACRA has encouraged providers to focus on quality and value-based care. This has led to improvements in patient outcomes, such as reduced readmission rates and improved preventive care.

Second, MACRA has promoted the use of HIT systems. HIT systems can help providers to improve communication and coordination of care, which can lead to improved patient outcomes and reduced costs.

Third, MACRA has encouraged providers to engage patients in their own healthcare. Patient portals can help patients to access their medical records, schedule appointments, and communicate with their providers. This can lead to improved patient satisfaction and better health outcomes.

Organizational Policies and Procedures:

The following organizational policies and procedures are/will be in place at our healthcare organization to address MACRA:

• EHR system selection and implementation: Our organization has a rigorous process for selecting and implementing new EHR systems. We evaluate EHR systems based on their ability to support MIPS reporting and other MACRA requirements.
• Quality improvement: Our organization has a quality improvement program in place that is aligned with MACRA requirements. We regularly collect and review quality data to identify areas for improvement.
• Patient engagement: Our organization has a patient engagement program in place that encourages patients to participate in their own healthcare. We offer patients access to a patient portal and other tools to help them manage their health.

Our organization is committed to complying with MACRA and improving the quality and efficiency of healthcare for our patients.

Examples of Specific Organizational Policies and Procedures:

• All providers must use the organization’s certified EHR system to document patient care and report quality data.
• Providers must participate in the organization’s quality improvement program and complete all required quality improvement activities.
• Providers must encourage patients to use the organization’s patient portal to access their medical records, schedule appointments, and communicate with their providers.
• The organization will provide training to all providers and staff on MACRA requirements and the organization’s policies and procedures.

Conclusion:

MACRA is a significant piece of legislation that is transforming the way healthcare is delivered and paid for. Our organization is committed to complying with MACRA and improving the quality and efficiency of healthcare for our patients. We have implemented a number of policies and procedures to support MACRA compliance, including EHR system selection and implementation, quality improvement, and patient engagement.