MACRA: Over 50 years in the making!

By Moshe Starkman, nThrive Senior Value-Based Reimbursement Consultant | Posted: 12/01/2017

After the recent elections, with a new political administration in the White House, the question I received most was “Do you think MACRA is going to be repealed or delayed?” At the time, I said no and explained that MACRA legally ended the SGR2 model and per force ensures that the new Quality Payment Program will dictate Medicare Part B FFS adjustments going forward.

Today I’m going to share with you a broader picture of Medicare and how its history dates back to the 1930’s when the President Franklin D. Roosevelt administration was grappling with how to “fix” health care while at the same time introducing social security. Medical benefits were deemed too politically risky to Social Security at the time and was shelved until Congress passed the first Medicare program in 1965 under Linden B. Johnson’s administration; with former President Truman and his wife as the first two card carrying members in 1967.

A brief history of Medicare

Medicare, from its inception, was intended to serve as universal health care for all US citizens. But questions about program affordability and government over reach reduced the program scope to solely cover the elderly. (With the program backer’s expectation being that a childhood version of Medicare would quickly follow.)

Furthermore, in addition to restricting the program to elderly care, Medicare was modeled after known insurance models and policies simply to pass political muster.

While noble in intent, the political influences of any substantial legislation resulted in a program that was inflationary in nature and seldom covered the services and devices prevalent in elderly care. In other words, this was a government mandated program designed on for-profit models. This resulted in ballooning costs coupled with limited health care coverage utility.

How MACRA fits in

This is not the forum for a full discussion on the history of Medicare but it is important to fundamentally understand that legislation like MACRA is not new and or temporary. It is the latest attempt to fix a 50-year-old political miscalculation.

Having said all of that, I’m pleased to share with you that, IMHO, this latest attempt has merit in its design and complexity and may actually bring US health care to higher levels of quality with limited or improved cost. In short, MACRA is an attempt to curb the rising costs of care while promoting quality best practices. Through these changes in reimbursement models, I feel that the government is a significant step closer to meeting the health care needs of society.

Next steps

Today the question is not “is the program going to be delayed or repealed?” but “are you prepared to meet contemporary quality reporting requirements?” It is not too late to get started, especially if you enlist help from a qualified registry.

We don’t how this story is going to end, but we do know what today’s chapter looks like and what you need to do to compete. Take the first step towards successfully navigating the future of health care by visiting the nThrive MIPS Registry page today to learn more about how your practice can get started on the historic journey from volume to value.

Sustainable Growth Rate reimbursement model that tied Medicare reimbursements to GDP.