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Many wound care practitioners may not realize it, but we are currently sitting in the “eye of a healthcare storm” due to the impact of quality payment programs, MACRA, and MIPS.
Some of us residing on the Gulf Coast know what it’s like to look up into the quiet sky inside the eye of a hurricane as it passes by and experience that eerie stillness before the gale-force winds resume. Many wound care practitioners may not realize it, but we are currently sitting in the “eye of a healthcare storm.” A new method of determining advanced practitioner (AP) payment began Jan. 1 under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Although the final rules governing MACRA provide exhaustive detail around the Merit-Based Incentive Payment System (MIPS), there’s more to it. The goal of this new Quality Payment Program (QPP)1 is to get all healthcare providers into Alternative Payment Models (APMs), such as accountable care organizations or patient-centered medical homes. Americans are facing “the perfect storm” that will significantly change traditional fee-for-service Medicare. In 2014, the Medicare hospital insurance (HI) trust fund went into the red by $14 billion.2 Medicare trustees estimate the HI trust fund will be depleted by 2030 unless we change our course. It’s interesting to note that in 2014, $8.1 billion in trust fund assets were “redeemed” to help cover the monetary shortfall through a variety of recoupment activities targeting fraud and “improper use.” These recoupment activities directly impact wound care and hyperbaric medicine providers who are experiencing unprecedented scrutiny driven in part by the urgent need to balance Medicare’s budget. Frustratingly, some studies suggest that the highest-spending providers are probably overusing healthcare services3 and that Medicare could stay afloat another two decades without the need to ration care if we just eliminated waste. That’s why the Centers for Medicare & Medicaid Services (CMS) intends to reward “better” care rather than “more” care with the QPP. While we sit here in the eye of the storm, we have a moment to think about the challenges that will be involved in transitioning all wound care stakeholders to a value-based system.
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Caroline Fife, MD    Twitter Facebook  |  LinkedIn

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