3 Things Every Locum Needs to Know about MACRA

3 Things Every Locum Needs to Know about MACRA

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The U.S. Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation that was signed into law on April 16 of that year. Among other things, MACRA repealed what is known as the Sustainable Growth Rate formula used to determine Medicare reimbursements to doctors, hospitals, and clinics. The impetus behind the legislation was to force a move away from the fee-for-service model and to an outcome-based model instead.

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Published 02 December 2017
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3 Things Every Locum Needs to Know about MACRA The U.S. Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation that was signed into law on April 16 of that year. Among other things, MACRA repealed what is known as the Sustainable Growth Rate formula used to determine Medicare reimbursements to doctors, hospitals, and clinics. The impetus behind the legislation was to force a move away from the fee-for-service model and to an outcome-based model instead.
Full-timelocum tenens physicianshave spent the last two years looking at MACRA with indifference. Taking such a view is not a wise idea. MACRA still affects locums even though they do not directly bill Medicare and insurance companies for their services. If you are locum tenens physician working full time on a contract basis, you still need to fully understand the implications of MACRA on the medical industry. It is going to affect you one way or the other once everyone gets up to speed. There are three things in particular you need to know. These are explained below. 1. MIPS and APM Models MACRA replaced the old way of determining Medicare reimbursements with two new models known as the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). As previously stated, full-time locums do not have to pay a lot of attention to MACRA because they do not bill d irectly for their services. Rather, they bill the institutions they work for. Having said that, locums still need to know the difference between MIPS and APMs for a couple of reasons. First, they are going to have to be familiar with both payment models should they ever leave locum work to pursue a position that will involve direct billing of Medicare and private insurance companies. There is a lot to learn about MACRA, so waiting until that time comes makes no sense. 2. Employer Requirements Next, full-time locums need to be familiar with MACRA because it influences employer requirements. Employers are now operating under one of the two previously discussed models which will, inevitably, impact the kind of service they provide patients.
Locum doctors are soon going to be expected to provide that same level of service irrespective of the fact that they do not bill insurance companies or Medicare. A locum unable to meet employer expectations will not be asked back to fulfill future contracts. 3. Future Contract Negotiations Last is the issue of future contract negotiations. Once all the dust from MACRA settles, it will be a lot easier to understand healthcare facility income based on the chosen fee model and the quality of service provided. Locum doctors will find that information invaluable when negotiating future contracts. Let's say you have a healthcare facility that is doing very well in meeting the standards of outcome-based delivery. As a result, their revenues are also strong. They expect any locum doctors they bring on to adhere to their standards of care in order to keep outcomes at their current level or, better yet, improve them. A locum doctor has every right to demand higher compensation commensurate with greater expectations. MACRA is an incredibly complex law that both doctors and healthcare facilities are having trouble wrapping their brains around. Some estimates suggest that the majority of those affected still are not fully on board. This is only temporary. Eventually the dust will settle, doctors and facilities will nail down their reporting obligations, and our healthcare delivery will move forward. Locum doctors have just as much interest in figuring it out as those healthcare facilities and doctors that bill directly.