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    Top 6 things physicians need to know about MACRA, Obamacare repeal

    Editor’s Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Anish Koka, a cardiologist in private practice in Philadelphia. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    Confusion reigns after a week that saw the release of the proposed 2018 rule for the law governing Medicare payment to physicians, known as the Medicare Access and CHIP Reauthorization Act (MACRA), only to be upstaged by the arrival of the latest iteration of the Republican healthcare plan for the nation: The Better Care Reconciliation Act (BCRA).


    Further reading: Physicians, healthcare industry react to 2018 MACRA proposed rule


    Condemnation of the BCRA is near unanimous the best I can tell. Republicans find the bill to be either not conservative enough, or too conservative and the Democrats have declared the bill  poison sure to rival wars in the deaths it will cause.Anish Koka

    It doesn't help that non-partisan analyses are difficult to find for the hapless physician who simply wants to know how this affects us and our patients, and by extension, our livelihoods. What follows are my best attempt to answer some important questions for fellow practicing physicians.

    1. Are there any fundamental changes to MACRA under a new administration (i.e. Health and Human Services Secretary Tom Price and Seema Verma, head of the Centers for Medicare & Medicaid Services)?

    Sadly, the current administration's version of MACRA reads like it was written by the prior administration. The cat-and-mouse game between Medicare and its physicians is very much alive and well.

    Avoiding a penalty in 2019 requires enrolling individually in the Merit-based Incentive Payment System (MIPS) or being a part of an Alternative Payment Model (APM). The MIPS track, as before, involves scoring points to provide value by reporting on quality measures. In the current year, a penalty may be avoided in 2019 by reporting on one quality measure for one patient to nudge physicians onto the value-based hamster wheel. There are some wrinkles to the proposed plan for 2018 (affecting 2020 payments).


    Even more info: Top 8 things doctors need to know about 2018 MACRA proposed rule


    The most significant is raising the low-volume threshold to $90,000 or less for Medicare Part B charges or 200 or fewer Medicare patients annually. The prior threshold was $30,000 or 100 Medicare patients. Surprisingly, only 36% of eligible clinicians cross this new threshold — though they do make up almost 60% of Part B charges. Other changes relate to bonus points for complex patients, reporting in virtual groups and easing requirements for the use of 2015 certified electronic health record (EHR) technology. In the end, these changes are not nearly enough to ease the stifling regulatory environment the current value-based regime finds itself enamored with. It puts small physician groups at a disadvantage.

    Next: 'A recurring, and understandable concern'

    Anish Koka
    Anish Koka is a cardiologist in private practice in Philadelphia trying not to read the writing on the wall. Follow him on twitter ...


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