Several Durango medical practices are already starting to see the positive effects of a new federal law that seeks to change the way Americans pay for health care, especially as it relates to Medicare beneficiaries.
“It’s just making us all better in how we run things,” said Larinda Wyatt, office manager at Rivergate Physical Therapy.
In March 2015, the Medicare Access and CHIP Reauthorization Act received overwhelming and rarely seen bipartisan support, with the House voting 392-37 and the Senate voting 92-8 in favor of the bill.
When it takes effect in 2019, MACRA will usher in a number of crucial changes to the Medicare and Medicaid reimbursement plan, which supporters contend was previously unsustainable.
With Medicare/Medicaid spending deemed out of control, Congress, in 1997, passed the Sustainable Growth Rate plan, which created a fee-for-service system where physicians were reimbursed for Medicare/Medicaid care.
In other words, clinicians were paid based on volume of services, not value, according to the Centers for Medicare and Medicaid Services.
However, the Sustainable Growth Rate did little to improve the situation, and by 2002, physicians were hit with a 4.8 percent reduction in Medicare reimbursement payments, according to a 2015 report by Nextech Systems technical writer Nathan Brown.
“Thus began over a decade of constant and regular ‘doc fixes’ to the SGR, a series of temporary (stop-gap) measures that did just enough to keep the whole Medicare and Medicaid system from falling apart,” Brown said.
Now, MACRA is intended to be the permanent fix to the flawed Sustainable Growth Rate, which was repealed with the passing of the new bill.
Under MACRA, “participating providers will be paid based on the quality and effectiveness of the care they provide” and “a growing percentage of physician payment will be based on value – not on volume,” according to the Network for Regional Healthcare Improvement.
With the new system set to take effect in 2019, many health providers must change the way they do business to meet the requirements set out in MARCA, said Barbara Martin, director of the Colorado State Innovation Model.
As a result, a free, federally funded initiative called the Transforming Clinical Practice Initiative (TCPi) was created to help health providers navigate that change, Martin said.
Now, 11 Durango health providers have signed up for TCPi’s help.
Practices are given a coach to help with the transition, who identifies how a facility can improve its way of doing things, such as implementing an electronic database and connecting other care providers.
“It requires practices rethink workflow and business model in a new way,” Martin said.
Rivergate Physical Therapy’s Wyatt, for example, said TCPi has helped find ways to streamline patient care, which has helped the facility become a more fined-tuned machine.
“It’s really a waste not, want not model,” she said. “The more we can help streamline the process, the more funds become available for more people.”
At Southwest Colorado Spine & Musculoskeletal Center, practice manager Steffi Neiman said the new federal requirements, along with TCPi’s help, have forced the practice to look at its longstanding policies and procedures, and then tailor them better to benefit patients.
Neiman said with all the recent upheaval in the health care industry, it’s hard to get excited.
“At the end of the day, though, the overall outcome from the program should benefit the patients, and that’s what’s important in medicine.”
Yet, Martin believes that because of the bill’s strong bipartisan support, MARCA is here to stay, even if the Affordable Care Act is repealed and replaced.
“This is legislation that’s in place, and we anticipate it will remain in place,” she said.
jromeo@durangoherald.com
