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MACRA, President Trump & ACA

With passage of the Affordable Care Act, President Obama declared a new chapter in healthcare delivery. A mere six years later, are we about to see a new chapter written? A quick Internet scan shows the powers-that-be might be working on a completely different book.

Before the election, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) seemed destined to become the acronym of the year. Despite a general consensus in the healthcare industry that MACRA was an improvement over the Sustainable Growth Rate framework it replaced, providers have plenty of concerns.

Dr. John Meigs, Jr., president of the American Association of Family Physicians told Medical Economics he has problems with the overall complexity of the rule, is disappointed that the virtual group implementation was delayed because it would benefit small practices, and is concerned that small practices will be held accountable for the total cost of care in future years.

Accordingly, industry groups like the Medical Group Management Association convened government affairs experts and offered conference sessions to help attendees understand the short- and long-term implications of MACRA.

CMS weighed in, with Acting Administrator Andy Slavitt saying that some of the concerns are being played up by those with an interest in having physicians fear MACRA. “If you are a hospital who wants to buy a physician practice…this is another thing you put in your pitch deck. If you are a consultant, that’s also in your interests,” he told Modern Medicine Network.

Republican physician lawmakers talked about a legislative fix if the final rule did not “get it right for patients and practitioners.” Tennessee Representative, Dr. Phil Roe told Modern Medicine Network that his group would, if needed, intervene to improve the regulations for the nation’s physicians.

These statements were made before the election, and now that Mr. Trump is President, the talk has shifted dramatically. Many in government are calling for a repeal to Obamacare, and some are calling for changes to MACRA. So, what should small and mid-sized practices do now?

Keep calm. MACRA rules, which took effect on January 1, will take years to fully implement (if they’re left alone). Additionally, although candidate Trump vowed to repeal and replace the Affordable Care Act, he more recently said he’d like to keep some elements of the law. He didn’t directly address MACRA, but the act had strong bipartisan support when it passed.

Carry on. The new regime began January 22, and Mr. Trump made significant changes on his first day in office, but MACRA may not be in the new administration’s crosshairs for a while. “Because MACRA puts long-term pressure on physicians to adopt Alternative Payment Models such as ACOs and bundled payments, any action to roll back those programs … would serve to undermine MACRA’s effectiveness,” HealthData Management noted.

Watch carefully.
Further across-the-board payment cuts would accelerate the trend toward physician practice aggregation already at work. Republicans who have voted for years to repeal aspects of healthcare reform now have their opportunity. Medicare and Medicaid might see major changes under a GOP-controlled White House and Congress.

Finally, small practices can aim to help answer the question “What comes next?” All providers—including small practices—must be part of the conversation with payers on deciding how providers and payers are going to be successful in risk, because the case could be made that the vaunted transition to value was slowing even before Mr. Trump was elected.

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