Here are a few of the top trends your wallet needs to watch in the coming year:
Physicians Adjusting to MACRA
MACRA stands for “The Medicare Access and CHIP Reauthorization Act”, which was implemented in 2015 to replace what was considered a flawed sustainable growth rate. It is not fully in effect yet, but it is vital that physicians take steps now to learn and understand all the implications that MACRA will have on their practice. In 2016, new rules took effect for quality reporting and payment policies, all of which substantially change the way Medicare’s physician reimbursement is handled.
Performance measurement for the new payment models are set to begin in 2017, so this year leading up to it may prove to be a critical time for physicians to begin learning about the details and implications of MACRA for their practices.
Susan DeVore, President and CEO of Premier, Inc., penned a recent Health Affairs blog, and stated that physicians face a critical task ahead of them when it comes to learning how to improve performance and avoid payment penalties under MACRA. She contended that they must devise a way to “developing more complex governance models, adjusting to more data sharing across the care continuum and more performance measurement,” according to Ms. DeVore.
The Basic Impact of MACRA 2016
- Physicians will have to learn how to developing more complex governance models, provide for greater levels of data sharing across all levels of patient care, and be subjected to more performance measurement. Though hospitals have been subject to the performance-based payment provisions of the Affordable Care Act (ACA), this kind of oversight is new for physicians. They will have to understand what must be done to improve performance or they will face payment penalties.
- Physicians and physician practices will have a choice in payment models, so they will have to undergo some level of financial planning in order to best determine which track presents the greatest results for their practice, taking into account its current level of performance.
- Finally, after they have selected a payment model, physicians must decipher better ways to organize themselves to take advantage of their choice. They will need to understand and utilize partner collaboration and testing, and better collaboration in order to secure long-term success.
Because of all the work involved in education, planning, preparing and complying with MACRA, it is expected to be a difficult, cumbersome, and expensive task. This translates to a possible increase in the number of physicians joining or affiliating with health systems. It is also expected that MACRA may also cause an increase in early retirements among some physicians, because of resistance and dislike of the new requirements.
Focus on Telemedicine Payment Incentives
Telemedicine has reached a pivotal point in the doctor-patient relationship, growing more popular over the last few years and presently being backed by several health plans including Cigna Inc. Approximately 15 million people tapped into this innovative, time-saving method to get medical advice and treatment in 2014. That figure was a 50 % increase for the prior year in 2013, according to the Telemedicine Association, showing rising popularity with consumers.
But, even though it has been recognized as an innovative method to better manage patient care, growth in the use of telemedicine has been slightly hindered by a payment incentive problem. In short, Medicare and several other private insurers refused to cover payment for telemedicine, unless there was a solid reason, like the patient lived in a rural area with a shortage of healthcare providers.
The times are changing, however. The mandatory Medicare bundled payment program actually waives the rural-only limitation, and new requirements on private payers may lead to increased use of telemedicine to meet new network requirements in 2016.
Reimbursement for telemedicine services is expected to be an ongoing challenge for many people, however. Of patients surveyed, 21 % said they received a lower reimbursement for costs from managed care companies for any telemedicine encounters versus face-to-face appointments, and 41% said they receive no compensation at all for telemedicine encounters.
But, it may be worth physicians investing in telemedicine. Even without reimbursement for implementation, which is arguably a costly endeavor, the investment can pay off if a healthcare provider participates in alternative payment models.
A great example of this is the Phoenix-based Banner Health, which was able to reduce hospitalizations and long-term care stays through an innovative program that allowed chronic care patient to utilize remote monitoring tools. Essentially, they provided tablet computers to their highest-cost chronic care patients, who then monitored and recorded their own daily vitals trough remote access to health apps.
Since implementing the project, hospitalizations and long-term care stays dropped, producing a savings of 27 percent. Because they participate in the Pioneer Accountable Care Organization (ACO) program, Banner then received 60 percent of that money returned to the health system in bonus payments that were used to offset some of its up-front costs.
Proponents contend that if patients can easily receive the preventative basic care they need through telemedicine, which in turn prevents expensive hospitalization, then insurance companies and the patients would actually save money. Researchers estimate that chronic diabetes care costs could be reduced by an average of 9 % each year if telemedicine was used effectively in lieu of more expensive office visits and hospitalizations. Aetna, estimates that those patients who fully participated in its telemedicine program over the six-month study period saved about $864,000 per patient.
With the increase in alternative payment plans, the use of smartphones and tablets as a convenient and trusted form of communication, 2016 may prove a time of growth for emerging telemedicine technology. One recent report projected that consumers that utilize home health technologies will increase to an incredible 78.5 million by the year 2020. That figure could also be conservative, mainly because of the new MACRA incentives for population health.
It seems like prescription drugs prices have been a concern for the last several years, and once more their rising costs has emerged as a primary concern for both healthcare providers and consumers. In fact, drug prices experienced an overall increase at an alarming rate of 12.2 percent in 2014, ranking as the highest rate of increase in more than a decade.
Prescription drug prices will continue to represent a major financial challenge for healthcare organizations throughout 2016, and there are few avenues of relief since both specialty and generic pharmaceutical drugs prices continue to be on the rise. According to Ms. DeVore, there will likely be an increased focus on driving market competition in 2016, in an attempt to control escalating drug prices.
“We anticipate the new FDA Commissioner will prioritize speed and market access of new drug approvals,” she wrote. “Shortening waiting lists as well as the lengthy approval process will go far to unleash positive competitive forces in the market, and drive prices down.”
Prescription drugs take up a large percent of consumers’ budgets, represented 9.8 percent of overall health spending in 2014, and estimated to have been approximately 10.1 percent in 2015. According to a report by the Peterson Center on Healthcare and the Kaiser Family Foundation, these rising prices and statistics are expected to reach about 10.4 percent by 2024.
Some consumers have found that the best way to access savings on a variety of prescriptions, from heart medication to drugs that treat male impotence, is through the use of a trusted online pharmacy. It is vital to be certain of that your pharmacy is a trusted provider, that it works with US-licensed physicians and pharmacists that dispense authentic, FDA-approved medications, and that it can provide substantial prescription savings and the benefit of home delivery.
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