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    MACRA changes deemed likely to survive new administration

    Ophthalmologists are likely to continue grappling with changes brought about by the Medicare Access and CHIPS (Children’s Health Insurance Program) Reauthorization Act (MACRA) under the administration of President Donald J. Trump, according to Ruth D. Williams, MD.

    While Trump’s promise to repeal the Affordable Care Act and replace it with “something much better and much less expensive” has attracted a lot of headlines, other recent regulations affect ophthalmologists much more, said Dr. Williams of the Wheaton Eye Clinic, Wheaton, IL, at the Glaucoma 360 21st annual Glaucoma Symposium.

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    “I don’t think the ACA is the most important thing that’s changing the way we practice medicine,” she said. “The most important thing is the integration of large healthcare systems. If the ACA goes away, we’re still going to have these large healthcare systems and we function within them.”

    Also, she pointed out, MACRA significantly altered requirements for physicians to be reimbursed under Medicare, and it’s not clear whether the new administration will seek changes in it.

    In October 2016, President Obama’s nominee for secretary of the U.S. Department of Health and Human Services, Rep. Tom Price, MD (R-GA), expressed skepticism of the final rule for MACRA.

    More from Dr. Williams: Value-Based Payment program presents potential ramifications

    “We are deeply concerned about how this rule could affect the patient-doctor relationship, and I look forward to carefully reviewing it in the coming days,” said Dr. Price in a prepared statement.

    Dr. Williams pointed out that MACRA passed with bipartisan support in both houses of Congress, including a 392-37 vote in the House of Representatives.

    She added that no one is eager to return to the regulations for Medicare reimbursement. These included a tangle of quality-reporting requirements and the Sustainable Growth Rate, which caused physicians to constantly lobby Congress for modifications.

    So for now, ophthalmologists should work under the presumption that major provisions of MACRA will remain in place, she said.

    That means understanding MACRA’s underlying agenda: shifting reimbursement models from volume to value. The principle tools for that shift are Merit Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).

    Under one alternative payment model, physicians ophthalmologists participate in groups of healthcare providers known as accountable care organizations (ACOs). These groups in turn may participate in shared savings programs under which practices are allowed to keep some of the savings to Medicare by reduced billing.

    Medicare Shared Savings program, MIPS

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