September 25, 2017 | Quality of Care Over Fee-for-Service Care

It’s no secret. The Medicare Access and CHIP Reauthorization Act (MACRA) has thrown many for a loop. When talking about or dealing with MACRA, many only look at the administrative burdens or change of workflows. If we stop and take a broader look, what is MACRA trying to solve? In fact, the Act provides payment incentives to physicians to enable them to provide timely, quality care to their patients. It’s also so they can move away from payment incentives that favor volume and fee-for-service care. By providing such incentives, doctors are paid more for better care, patients receive improved quality of care, and overall healthcare costs are reduced.

Emphasis on Quality of Care

The goal behind MACRA is not to point fingers and say that the current care given is poor or not meeting certain standards. In reality, this emphasis on quality is to allow physicians to spend the necessary time with their patients in order to provide the best care they can. This way, they won’t need to keep us with as many patients in order to receive the same compensation.

According to a CMS analysis, when total payments for doctors are based on the overall volume of services given, the efficiency levels decrease. This is due to time-intensive services rendered such as preventive medicine, screenings, patient education and more. Fee-for-service payment systems don’t completely allow physicians to provide the utmost quality of care they always wish to give. Hence, the implementation of MACRA.

“Primary care practices should receive a separate, risk-stratified care management fee for each of their patients. This capitated fee should be calculated and paid prospectively on a monthly basis (or at least quarterly), and it should be without risk to the physician and free of patient cost sharing. […] This approach would allow such practices to diversify available resources to better manage ancillary care needs and provide other services that yield improved, cost effective care.” – aafp report


Additional Quality Care Services

When speaking of cost-effective care and additional services, most often, the two don’t go together for physicians and practices. Providing additional services means requiring additional resources whether it be time, staff or other. So how does one provide additional care while still being cost-effective?

Medicare is responding to all of this. With the many reimbursements for services such as Chronic Care Management and Annual Wellness Visits, what many physicians and practices are realizing is that providing these valuable services also increases their bottom line.

MACRA is betting on increased quality of care through better services will decrease the overall cost of healthcare. This further reinforcing their decision to reimburse physicians for additional quality care services. Through these services, many MIPS (Merit-based Incentive Payment System) categories and measurements within MACRA are easily met.

Providing Chronic Care Management (CCM) services allows physicians to receive an average of $42 per patient per month for patients with two or more chronic conditions. Other services such as Annual Wellness Visits (AWV) offer physicians an annual reimbursement of $172 per patient for the first visit and $111 for all subsequent visits.

“Our patients who have enrolled in CCM are notably more engaged in thinking about their diseases and how they can proactively work with us to address them. They are much less inclined to sit on the sidelines and passively receive medical care. Patients appreciate the monthly phone call and extra services now available to them.” — Dr. Peter Weigel Medical Associates of Westfield – Westfield, NJ

With the ability to render timely, distinct care, physicians can be assessed on the quality of their care rather than their volume. Going beyond this, outsourcing valuable services like CCM and AWV allows physicians to increase their care services and quality of care. It also allows them to educate and empower their patients, increase their revenue and meet important MACRA requirements in the process. This is all without changing the way they currently work.

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