On April 16, 2015, President Obama signed the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA) into law. With that passage, the flawed Sustainable Growth Rate (SGR) program has been eliminated, a victory to be celebrated by the medical community. Aside from that win, the act also includes other important legislation that will substantially affect the healthcare industry.
One of the most significant changes is the proposed amount of risk physicians and hospitals will need to take in dealing with traditional Medicare. In 2016, 30% of healthcare will be required to be delivered by alternative payment models, rising to 50% in 2018. Although not yet defined, it’s clear that when MACRA takes effect, providers will be required to assume an even greater amount of risk. That forecast leads us to the critical question of how to deliver efficient healthcare that is both high quality and low cost.
Physicians and hospitals will need to approach this population health issue from a different perspective than before. With a responsibility to patients’ health and a fixed amount of funds, they’ll need to look at how to deliver healthcare within the confines of providing high-quality service at a lower cost. We expect to see more involvement in preventative medicine and providers who place more attention on determining the most efficient and cost-effective methods for patient care. This will impact many areas throughout healthcare, especially cardiovascular care.
Today, individuals are directly purchasing their healthcare and consumers are increasingly more aware of their out of pocket costs. With the amount of public information available, including individual physician and hospital comparisons, it’s incredibly important for providers to strike a balance in terms of cost and quality. Being competitive is not only a benefit for patients but also from a business perspective. Insurance companies must evaluate and choose the top tier of providers who offer the best combination of cost and quality. Those that don’t make the cut could stand to lose current patients as well as access to future patients.