Weighing MACRA’s long-term effect on healthcare

Editor’s note: This is the second of a two-part interview with Eric Schneider, MD, senior vice president at The Commonwealth Fund, on the impact of Medicare payment reform legislation. In October, the Centers for Medicare & Medicaid Services (CMS) released the final rule spelling out how the Medicare Access and CHIP Reauthorization Act (MACRA) will be implemented.

 

Part 1 of the interview looked at how MACRA will affect small practices. Part 2 examines MACRA’s possible effects on the healthcare marketplace and health information technology.   

 

Medical Economics: You mentioned commercial payers a minute ago. I presume they’re keeping a close eye on what happens with MACRA. Will we see more of them going to some form of quality-based reimbursement model?

Eric Schneider: I think in several locations around the country [commercial payers have] really been ahead of the curve on that. To the extent that MACRA introduces additional tools they could use as quality measures or the practice improvement activities, the commercial payers will likely adopt those into their contracts.

Several commercial payers have been in the pay-for-performance business for quite a while. This might open up a channel for them to do it with small practices in a way that they haven’t been able to before.

ME: Was CMS looking at any of those when they drew up their criteria? Were they aware of what commercial insurers had been doing, and did they use that as a model in some way?

ES: I think they are. If you look at the Alternative Quality Contract in Massachusetts or some of the other payment contracts that have been described in the literature, those also include bonus payments for performance on quality measures, [and] shared savings in some cases for reduced cost.

What’s a bit unusual for CMS is that they’re adjusting fee payments rather than global payment with bonuses, so it’s a little bit of a different mechanism than what you’d see in the typical commercial insurance contract.

ME: Shifting gears to technology, given the importance of being able to exchange data electronically do you think MACRA is going to stimulate innovation to get us to interoperability quicker?

ES: I’m not sure MACRA will do that much. It’s a step in the right direction. The question is how the EHR vendors and clinical billing vendors will respond.

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