It’s here! Last Friday morning The Centers for Medicare & Medicaid Services (CMS) released the long awaited final rules on physician payment under the Medicare Access and CHIP Reauthorization Act (known as MACRA).
The Washington Post, MedPage Today, and others reported the CMS release of new rules and regulations to implement a “far-reaching overhaul of how it pays doctors and other clinicians”. “CMS announced the final rule for physician payment, the first major overhaul of the system in decades.”
“The goal is to reward quality, penalize poor performance and avoid paying piecemeal for services for the program’s 57 million elderly and disabled beneficiaries.”
James Furbush has written, “For existing health care practices and organizations, perhaps especially the large health care systems, making the transition away from the traditional fee for- service model of care to the new population based health model will not be easy”
“The goals of population health are clear: To improve the quality and effectiveness of care
while controlling costs for a defined group of people.”
Megan Clark of The Advisory Board Company notes, “the transition path couldn’t be murkier.”
“Many healthcare leaders struggle to define a vision for population health because it requires a different care model than they’ve been used to under fee-for-service.”
And many health care leaders are concerned that focusing on population health will undermine near term revenue — that is, a healthier population will require fewer hospitalizations and procedures. That threatens administrators’ salaries as well as the income of their staff and now salaried medical providers who have come to depend on those revenue streams.
Leaders report that doctors are reluctant to enter into risk-based contracts, fearing they may be unfairly penalized on already low profit margins.
The greatest cultural challenge for healthcare leaders is realigning an organization’s focus away from acute, episodic care and towards a team-based, collaborative model for sustaining wellness across a population.
It is exactly a team-based, collaborative model for sustaining wellness that we propose for the Boothbay Region Health Center.