MACRA and the Promise of Better Patient/Family Engagement in Post-SGR World

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The story of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) actually begins in the previous millennium. In 1997, when the Congress passed the Balanced Budget Act, it ushered in the era of the Sustainable Growth Rate (SGR) formula. In theory, the SGR payment adjustment would raise or lower physician reimbursement each year based on spending relative to the target SGR. The caveat, however, was that Congress had the authority to suspend or adjust this benchmark, a "patch" that they regularly deployed through a "doc fix" for nearly two decades.
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When President Obama signed the bipartisan MACRA into law in April 2015, it did a lot more than simply repeal SGR. Congress designed MACRA to modernize Medicare physician payment and reward better healthcare value in several ways. Thus, MACRA has many important implications for the future of health care delivery in the United States, including advancing the role of patient engagement throughout healthcare.

We’ve distilled MACRA’s patient engagement elements into four main categories:

1. Qualified Clinical Practice Improvement Activities for the Merit-based Incentive Payment System (MIPS).

In order to help shift physician payments along the spectrum from volume to value, MACRA established the MIPS to hold accountable providers who are not practicing in a qualified alternative payment model (APM). Furthermore, within the MIPS program, a number of the qualifying clinical practice improvement activities have strong elements of patient engagement:

  • Expanded practice access
  • Care coordination, such as timely communication, timely exchange of clinical information to patient, and use of remote monitoring or telehealth
  • Beneficiary engagement, such as the establishment of care plans for self-management assessment and training, and using shared decision-making mechanism.

This incentive structure will likely drive physicians to increasingly engage patients throughout the care process.

2. Patient-Reported Outcome Measures (PROMs) and Patient Experience Measures.

In the section on priorities and funding for measure development, MACRA charges the Secretary with developing a plan for quality measure development, including, but not limited to care coordination and patient and caregiver experience. Under those broad categories, the Secretary is supposed to prioritize

  • Outcome measures, including patient-reported outcome and functional status measures
  • Patient experience measures
  • Care coordination measures

Laying patient engagement as the foundation of quality measure development and reporting will both involve patients in those immediate processes, and also incentivize providers to think about ways to engage patients and improve their quality scores.

3. Expansion of Telehealth.

To improve patient access to healthcare services, MACRA creates pathways by which Medicare can reimburse physicians for services provided remotely, thereby establishing yet another avenue for patient engagement outside the clinic setting. Telehealth, remote monitoring and related services can help address access issues and both figuratively and literally “meet patients where they are.” This practice is particularly helpful for patients who have trouble getting to their providers for various reasons-distance, money, time, etc.-and creating a more continuous cycle of care management.

4. Provider Transparency.

Section 104 of MACRA not only seeks to “empower beneficiary choices through continued access to information on physicians’ services,” but also puts an emphasis on providing the data in an easily understandable format. This latter element demonstrates a commitment to patient engagement, at the very least acknowledging that healthcare data are often complex and beyond the reach of the average consumer. To provide these data to Medicare beneficiaries without considering the end users’ capacity to digest the information would do little to empower beneficiary choice, and would be an empty effort at patient engagement. That said, MACRA’s calling out the need for transferring information in a consumer-conscious way shows the push for engaging, informing and activating patients in their healthcare.

Key Takeaway

Several sections of MACRA will accelerate the increasing industry trend that has heightened patient engagement as a priority in the design and evaluation of healthcare models. Especially with regard to quality improvement and reporting measures, the Act emphasizes the need for incorporating the patient and caregiver experience into the care process. By creating financial incentives and penalties around patient engagement, MACRA helps lay the groundwork for increasingly patient-centered healthcare payment and delivery systems that actively incorporate the patient into the care team to achieve lower costs and better health outcomes.

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