Pros and Cons of MACRA: It’s a Business Decision

Pros and Cons of MACRA: It’s a Business Decision

ACA and Best Practices Academy team up to provide education on value-based reimbursement.

Author: Scott Munsterman/Friday, June 23, 2017/Categories: Practice and Payment

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Scott Munsterman, DC, FICC

Having had the opportunity to speak across the nation regarding the new Medicare quality payment program, I soon realized how emotionally charged our colleagues are about the concept of “one more thing.”

One more thing … added to the list of all the other things we have to deal with or at least should deal with; but that, frankly, our profession isn’t dealing with. What am I talking about? Regulations that affect the healthcare industry. And we are in the crosshairs because we are health care professionals, defined as “physicians” in many states (including Medicare) and our practices are affected by it. This cold, hard fact rings true for many practices that have experienced post-payment audits and recoupments, HIPAA violations with fines and public reporting.

In addition, insurance copays and deductibles continue to rise with benefit plans not covering all the procedures provided by chiropractors--even though in many cases the chiropractor delivers better quality care within a lower cost parameter. And the last "one more thing"…not getting the respect of being a valued member of the healthcare delivery team. All of these “things” add up to obstacles (or opportunities) for our profession. You get to decide.

So yes, the average chiropractor is swamped with the emotion of one more thing. I get that. But it’s time to think about your practice as a business. That’s right; get over the emotion of it all and realize you are a professional AND a business owner competing within the healthcare delivery marketplace. Your marketplace is changing, so it’s time to pick yourself up and listen--and listen closely.

MACRA Changes How You Are Paid

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes how providers are paid, moving from fee-for-service to the value-based model, which hinges on paying providers based on performance of clinical activities and outcome measures, determined to improve the quality of patient-centered care. There is a business decision to be made here based on sound facts, important understanding of the implications of strategic planning, and general common sense. Should your practice become involved in the value-based reimbursement system, namely the Merit-based Incentive Payment System (MIPS)?

For the first time – probably ever – you have the opportunity to raise your fee schedule based on your performance. The chiropractic profession has said for decades: Just give us a chance and we will show the world how well we can improve the health and well-being of the human body. We have said: Give us an opportunity to show you we can outperform our medical colleagues in the area of neuromusculoskeletal care. We have said: We are portal-of-entry providers, versed in primary health services…. We differentially diagnose patients; we are required to do so. We are clinicians.

Have those just been words? Or are we ready to prove up?

The Merit-based Incentive Payment System (MIPS) program is chiropractic’s opportunity to show its value within the care delivery system and amongst health care providers. The crossroad for the chiropractic profession is here and it has come in the form of what the public deems as essential for care delivery and the health and well-being of a nation. It involves seven key decision points each practice must engage to analyze the business aspect of the new payment system. Click here to learn more about this and the learning opportunity presented collaboratively by the American Chiropractic Association (ACA) and Best Practices Academy. Look for the  “MACRA, MIPS & Chiropractic: Medicare's New Quality Payment System” on-demand webinar series, which provides an overview of the MACRA law, defines how DCs can participate in the new MIPS program, and offers information about how to achieve performance standards for reimbursements in the future.

Dr. Munsterman is president of Best Practices Academy, which provides focused leadership to equip value-based practices and improve clinical outcomes. 




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2 comments on article "Pros and Cons of MACRA: It’s a Business Decision"

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Thomas Stotz

6/29/2017 10:13 PM

I have known Dr. Munsterman for many years. He has had a vision for the future for the way in which doctors will be reimbursed for our work that few in our profession recognized until the passage of the MACRA Law. Because of his vision and guidance through Best Practices Academy, we became the first group of chiropractic locations to be certified as Patient Centered Connected Care DC's by NCQA. Currently, we are working through the Iowa Healthcare Collaborative via Compass PTN (practice transformation network) to help us get up to speed with the MIPS program established by the MACRA law. Yesterday, I had the opportunity to receive a phone call from Paul Rosen, MD who is the chief medical officer at the Centers for Medicare & Medicaid Services. We had a productive conversation about several issues including the challenges facing DC's to meet the 6 quality measures in the MIPS program which must be tied to E & M codes that are not covered by Medicare which places an undo financial burden on our senior citizens.

The bottom line for me is that all of these accompiishments never would have happened without the vision and guidance of Dr. Scott Munsterman and Best Practices Academy.

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AJ Lau

12/17/2017 3:38 PM

Nice post, informative. We just wrote a blog post on MACRA @

MACRA will be re-introduced in 2019, and will be a significant change in healthcare reform as a new model for Medicare reimbursement. The current model reimburses the provider based on volume. The new model will now require the provider to provide information on the quality of service being given, how valuable it is to the patient, and accountability that provider has to the treatment being performed. In order to measure these parts of service together, MACRA has a three part system put in place:

PQRS, Physician Quality Reporting System

VBM, Value Based System

EHR, Electronic Health Record

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