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MACRA rules: Ten things to know about the new healthcare law

An expert's tips for how physicians paid by Medicare can begin to navigate the quickly accelerating transformation into new payment models -- and the related technology -- under MACRA.

Here are 10 things to know about the new MACRA rules for Medicare reimbursement of physicians, including data's...

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The MACRA tips come from Richard Royer, CEO of health IT consulting firm Primaris, based in Columbia, Mo., who spoke about MACRA -- the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act -- at the Health IT Summit conference in Boston in June.

  1. Physicians will select from 300 clinical measures embedded in the MACRA rules, 80% of which are already in the Patient Quality Reporting System.
  2. Providers should optimize their data and use metrics that measure medical outcomes.
  3. Value-based care models are significantly data driven. So providers must not only continually measure, but also continually analyze patient health data, not just collect it
Richard Royer, CEO, PrimarisRichard Royer
  1. Care coordination will be a critical success factor in all types of quality measurement and alternative payment model programs under MACRA rules. Providers will need to communicate and coordinate with each other as patients with chronic conditions move from hospital to skilled nursing to long-term care to home health. Interoperability will be critical so providers can know how to share bundled payments.
  2. Value-based reimbursement -- earning incentives and avoiding penalties -- is based on performance.
  3. The Centers for Medicare and Medicaid Services can award extra bonuses to high-performing doctors and impose further penalties on low-performing ones.
  4. Quality measurement, including such metrics as hospital readmissions and use of outpatient care settings, will start in January 2017 under MACRA rules.
  5. Medicare payments based on quality measures will start being adjusted in January 2019.
  6. There's a "take a break year" from quality measurement in 2018.
  7. Population health is important because alternative payment models will use data and quality scores about populations of patients, not individual patients.

Next Steps

The MACRA final rule for health data-quality met with guarded, mostly positive reaction 

Rules for merit-based reimbursement and alternative care models

Care coordination for population health analytics

ONC's interoperability measures under MACRA

This was last published in July 2016

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