As healthcare continues to evolve, the role of the nurse informaticist becomes increasingly important in ensuring the compliance of healthcare organizations with various policies and regulations. One such policy is the Medicare Access and CHIP Reauthorization Act (MACRA), which has significant implications for healthcare professionals. This fact sheet aims to provide a brief overview of MACRA and its impact on system implementation, clinical care, patient/provider interactions, and workflow. Additionally, it will highlight the organizational policies and procedures that will be in place at our healthcare organization to address MACRA.
Overview of MACRA
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015 and introduced new guidelines for the reimbursement of healthcare services provided to Medicare beneficiaries. MACRA repealed the Sustainable Growth Rate (SGR) formula, which was previously used to calculate Medicare payment rates. The law also established the Quality Payment Program (QPP), which is the framework for implementing MACRA.
The QPP has two tracks for eligible clinicians to participate in: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MIPS is a performance-based payment system that adjusts Medicare payment rates based on the quality, cost, improvement activities, and the use of certified electronic health record technology (CEHRT). On the other hand, APMs provide financial incentives for eligible clinicians who participate in innovative payment models that focus on high-value care delivery.
Impact on System Implementation
MACRA has a significant impact on system implementation within healthcare organizations. To comply with MACRA, eligible clinicians must demonstrate their meaningful use of CEHRT and report on quality measures. This requirement necessitates the implementation and optimization of electronic health record (EHR) systems that are capable of capturing and reporting the necessary data. Healthcare organizations must invest in training and support for clinicians to ensure they can effectively navigate and utilize the EHR systems to meet MACRA requirements.
Impact on Clinical Care, Patient/Provider Interactions, and Workflow
MACRA has clear implications for clinical care, patient/provider interactions, and workflow. The focus on quality measures and the use of CEHRT encourages the adoption of evidence-based practices and the integration of decision support tools into clinical workflows. This can lead to improvements in patient outcomes, as clinicians have access to real-time clinical decision support and patient care recommendations based on the latest evidence.
Additionally, MACRA promotes the engagement of patients and families in care decision-making, as it emphasizes patient-centered care. This shift in focus may require changes in the way providers interact with patients, involving them in shared decision-making and empowering them to take an active role in their healthcare. Providers may need to allocate additional time for discussions with patients and ensure that they have access to the information necessary for informed decision-making.
Organizational Policies and Procedures
To address the requirements of MACRA, our healthcare organization has implemented several policies and procedures. Firstly, we have established a comprehensive training program to ensure that all eligible clinicians understand the requirements of MACRA and how to effectively use CEHRT. This includes initial training on system implementation as well as ongoing education to support clinicians in optimizing their use of EHR systems to meet MACRA requirements.
Additionally, we have developed standardized protocols and workflows to promote the integration of evidence-based practices and decision support tools into clinical care. These protocols provide clinicians with guidelines and tools to enhance the quality of care while meeting the requirements of MACRA. We have also implemented patient engagement strategies, such as shared decision-making tools and patient portals, to support the collaborative approach to care encouraged by MACRA.
In conclusion, the Medicare Access and CHIP Reauthorization Act (MACRA) has significant implications for healthcare organizations. It requires the implementation of CEHRT, the reporting of quality measures, and the promotion of patient-centered care. These requirements impact system implementation, clinical care, patient/provider interactions, and workflow. Our healthcare organization has implemented policies and procedures to address these requirements, including training programs, standardized protocols, and patient engagement strategies. By ensuring compliance with MACRA, we are committed to delivering high-quality care and improving patient outcomes.