Tag Archives: MACRA

Top 10 healthcare trends for 2017

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2017 will be a transition year shaped by changes proposed by President-elect Donald Trump and a Republican Congress. Chief healthcare concerns include legislative proposals to “repeal and replace” the Affordable Care Act (ACA), along with the continued movement to implement alternative payment models (APMs) as called for in the Medicare Access and CHIP Reauthorization Act (MACRA). We will address the potential changes ahead when it comes to shifting health benefits, provider supply, new care models, transparency, and the continued growth of consumerism. 2017 will be a dynamic year as we pivot and move in a new political direction.

Gut check: Change is coming, and healthcare executives don’t necessarily think it’s a bad thing

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Self-Discovery

The future of healthcare policy is a bit murky these days. President-elect Donald Trump has pledged to repeal the Affordable Care Act, and the Republican-run U.S. Congress is already fast at work to make that happen.

What’s not known, however, is what will change for the thousands of U.S. healthcare businesses that have not only adapted to the ACA but also made millions in investments in areas such as electronic health records, value-based reimbursement and reporting to align with the policies of the outgoing administration.

Healthcare Finance spoke with several executives at healthcare businesses to get their perspectives on not only the changes they expect but also their thoughts on what the healthcare sector actually needs to do to provide the best care while still safeguarding the health of its business model.

 

Top managed care trends to watch in 2017

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Top 10 challenges facing physicians in 2017

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http://medicaleconomics.modernmedicine.com/medical-economics/news/top-10-challenges-2017

2016 was a challenging year on many fronts for healthcare providers.

Physicians have just started to digest the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its changes to physician reimbursement. A long presidential election finally reached its conclusion, but the consequences of a Republican Congress and President-elect Donald J. Trump for U.S. doctors and patients remain unclear. And running a private practice did not get any easier. Balancing the need to deal with patients who won’t listen or won’t pay while also seeking positive patient satisfaction scores remains a daily struggle for many. 

These were just some of the challenges physician readers told Medical Economics they experienced this year and anticipate continuing for the foreseeable future. 

For the fourth consecutive year, Medical Economics reveals its list of obstacles physicians will face in the coming year and, more importantly, how to overcome them. For this latest presentation, we asked readers to tell us what challenges they face each day and where they needed solutions.

Here are their responses, starting with the biggest challenge of the coming year.

How doctors can overcome payment obstacles in 2017

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Survey: 70% of medical groups worried about MACRA implementation

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http://www.beckershospitalreview.com/finance/survey-70-of-medical-groups-worried-about-macra-implementation.html

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Almost three-quarters of employed medical groups are concerned about implementation of the final Medicare Access and CHIP Reauthorization Act rule, according to The Advisory Board’s survey of the Medical Group Strategy Council.

The Advisory Board said it recently surveyed a group of 30 employed medical groups to determine their concern about MACRA and see how they’re adjusting to the changes MACRA will cause.

Here are five survey findings.

1. Seventy percent of respondents are “concerned” or “totally freaked out” by MACRA. Of the remaining respondents, 20 percent are “confident,” while 10 percent are “ambivalent,” the survey found.

2. The MACRA final rule, a landmark payment system for Medicare physician fees that replaces the sustainable growth rate formula, includes two pathways for provider participation: the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model. According to the survey, 70 percent of respondents anticipate participating in MIPS, while the remaining 25 percent predict they will fall into the APM category.

3. Only half of the medical groups that believe they will participate in MIPS expect to be prepared to report data for the entirety of 2017, according to the survey. Another 21 percent anticipate choosing the partial-year option to be eligible for the smaller positive payment adjustment, and 29 percent of respondents planning to “test the program” by reporting nominal data to avoid the negative payment adjustment.

4. The Advisory Board said 58 percent of survey respondents identified MACRA as the driving force for consolidation efforts in their markets.

5. However, the other 42 percent of respondents have not observed MACRA affecting consolidation decisions in their markets, The Advisory Board said. “This could be a result of the additional support for small practices CMS included in the final rule. But we’re still in the early stages of MACRA implementation, so this may change during the coming year,” The Advisory Board added.

How will Trump change healthcare? 6 of the biggest questions answered

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Throughout his campaign and in the days following the election, President-elect Donald Trump said that one of his top priorities as the commander in chief would be to repeal and replace Obamacare, a major component of the Affordable Care Act (ACA). By having a Republican president as well as the GOP holding a majority in Congress (which also support its repeal), it’s likely that this will occur, says Ashraf Shehata, MBA, advisory leader for health plans and partner of the firm’s Global Healthcare Center of Excellence, KPMG.

But how do you go about replacing Obamacare when 20 million Americans are now obtaining healthcare coverage from it?

Hospital executives’ 12 most pressing post-election questions, answered

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https://www.advisory.com/Research/Health-Care-Advisory-Board/Expert-Insights/2016/2016-Election-12-Questions-Every-Executive-Should-Be-Asking

In a stunning upset, Donald Trump took the stage early yesterday morning to claim victory as the next president of the United States while Republicans celebrated retaining control of both the House and the Senate.

While the outcome of the election has long been expected to have a far-reaching impact across a number of policy areas, the Republican sweep of Congress and White House could result in profound changes in health policy after a hard-fought election on both sides of the aisle.

Although the exact implications of the race will become more apparent in the coming days and weeks, we expect Republicans to emphasize the election results as a mandate for change and use the opportunity to pursue significant new initiatives.

So what can providers expect from a Trump administration and a GOP Congress? Let’s take a look at what’s potentially in store for Medicare, Medicaid, and the private insurance market—and what those changes mean for provider strategy—by looking at the most common questions I’ve already received following the election.

No Matter What, Congress Will Act On Health Care Next Year

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http://healthaffairs.org/blog/2016/11/07/no-matter-what-congress-will-act-on-health-care-next-year/

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When Congress passed the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) last year, House Energy and Commerce Committee Chairman Fred Upton (R-MI) said “stick a fork in it; it’s finally done.” While some elements—especially Medicare’s long-flawed Sustainable Growth Rate formula—were permanently remedied, other provisions were temporarily addressed by the bill and come due again in September or December of next year.

So, while the presidential candidates and others consider broad-based health care policies, the passage of which in the near term is dubious, there is a wide array of issues we can bank on Congress taking up, likely in one, consolidated legislative package.

Funding for the CHIP program may be the foremost among these issues, accompanied by a batch of expiring Medicare “extenders” that Congress typically addresses before they lapse. These provisions, which used to reliably hitch a ride on perennial “doc fix” legislation, are expected to travel together in a bill that, along with Food and Drug Administration user fee reauthorizations, is among a few must-pass health bills in 2017. The package will begin to take shape early in the next Congress and ideally gain focus by spring to give states lead-time for budgetary planning, especially with regard to the CHIP and Medicaid components.

Last year, Senate Democrats pushed for a four-year CHIP funding reauthorization, which would have aligned CHIP funding with the Affordable Care Act’s reauthorization of the program itself through 2019. Their efforts fell short in MACRA, although a two-year funding reauthorization keeps the program in the clear until Sept. 30, 2017.

While it’s early to predict what will be included, we anticipate the following potential items will likely be considered in this CHIP funding and Medicare extenders package:

4 forces that will influence medical cost trends in 2017

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http://www.healthcaredive.com/news/4-forces-that-will-influence-medical-cost-trends-in-2017/421162/

The healthcare industry is in a transformational period. The rising use of retail clinics, MACRA, population health efforts and the Medicare Part B demonstration are but a few examples of disruptive conversations being had in board rooms. Yet, all of these discussions are underscored by the one topic underlying most business conversations: the almighty dollar.

There’s been plenty of digital ink given this year to the costs surrounding the industry. Just last week, a new Kaiser Family Foundation report outlined how the cost for the most popular ACA plan – the silver plan – is expected to rise on average 10-11% next year. Healthcare costs are generally expected to increase each year but, for context, the average silver plan increased an average of about 5% the previous year, according to the report.

However, a new PricewaterhouseCoopers’ (PwC) report stated while health prices are increasing, they are being tempered by the demand for value. PwC’s Health Research Institute (HRI) projects the medical cost trend – the projected percentage increase in the cost to treat patients from one year to the next – won’t increase or decrease next year but will stay the same as 2016: a 6.5% growth rate for 2017.

The report shows there’s a push and pull between healthcare services utilization and narrow networks focusing on value that could shift the medical cost growth rate in future years. “When medical growth outpaces general inflation, a flat trend is not good enough,” the report states.

“As a result, 2017 will be a tough balancing act for the health industry,” the report states, adding, “Healthcare organizations must simultaneously increase access to consumer friendly services while decreasing unit cost. Employers, worried that this current trend is at an inflection point that could turn back up, will demand more value from the health industry.”

HRI highlighted four factors that will influence the 2017 medical cost trend.