MACRA and MIPS: Getting the Big Picture

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) officially ushered in the value-based model of reimbursement, beginning a change to the payment landscape of American health care. But what does this mean to providers? What does it mean overall for you as a chiropractic physician?

First of all, we shouldn’t be afraid of the deck being “reshuffled.” Anytime there is a change in a system – especially a system that has delayed or avoided change – it becomes ripe for an innovative, landmark transformation. Think back to 1989 (or do a Google search if you were too young to remember) when the Berlin wall fell. The wall physically and ideologically divided East and West Germany from 1961 to 1989; it seemed as though communism would never change, but the incremental and gradual drip, drip, drip of public opinion and time literally started tearing the wall down in one day.

Likewise, there has been a wall between the chiropractic profession and key decision makers in health care (i.e., public and private payers, employers, medical providers, public policy makers) until now. Today we can say the wall has come down. The wall of the “Why chiropractic?” really doesn’t exist anymore. Medical professionals and public policy makers are now looking for alternative solutions and different ways of doing business in health care – a different pathway to success, if you will, in patient care and cost control.

The question of “Why?” has been answered, but it brought forward a new question: “Who?” That is, who should I refer my patients to for spine care? Who should be on the front line for our health plan members who we can trust to provide an evidence-informed, cost effective approach within an integrated care pathway? Health systems, public policy makers and payers are asking these questions and more – right now. The deck is most definitely getting reshuffled thanks to MACRA.

Moving from fee-for-service to the value-based model hinges on paying providers based on performance of clinical activities and outcome measures that have been determined to improve the quality of patient-centered care. These measures are largely key health risk identifiers that bring light to the clinician and begs the question: “What should we do to get and/or keep this patient healthy? Which providers are the best to treat certain conditions? Where does the patient receive the best experience in care?” We already know the answers to these questions.

Chiropractors have long awaited an opportunity to fight their way to the front of the line – even to the middle – with some success at times. But now is the time for our profession to put a stake in the ground with key decision makers in health care. It is time to move the profession into a whole new perspective: an established role on the care delivery team.

Getting the big picture yet? We would love to hear more from you about your role in the care delivery system – right where you are in your community, in your state, in this great country. Include your thoughts in the comments section below.

MACRA, MIPS & Chiropractic

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.