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President's Message

Navigating Changes Enacted by MACRA

Portrait of Chris Troianos, MD

The discussion on healthcare reform occurring in Washington, D.C., town hall forums, and various media outlets can certainly have an impact on the delivery and access to health care in the years ahead. But the major change that determines the way physicians are paid through governmental insurance programs actually went into effect on January 1, 2017.

The Medicare Access and CHIP Reauthorization Act, also known as MACRA, was passed by Congress and signed by then-President Barack Obama in 2015. This law replaced the Sustainable Growth Rate (SGR) model of reimbursement that threatened to cut fees paid for medical services. Each year, literally “an act of Congress” was required to delay implementation of those cuts in reimbursement.

The changes enacted by the 2015 MACRA legislation are now a reality. Unless you are in some type of Advanced Alternative Payment Model, you will need to submit data according to the Merit-Based Incentive Payment System (MIPS). MIPS is composed of 4 components: quality data collection, cost, advancing care information, and improvement activities.

Clinicians who bill more than $30,000 to Medicare and provide care to more than 100 Medicare patients per year are eligible to participate in the Quality Payment Program. Physicians, physician assistants, nurse practitioners, clinical nurse specialists, and Certified Registered Nurse Anesthetists (CRNAs) are eligible providers when they meet these billing and service criteria. Clinicians were able to begin collecting performance data on January 1, 2017, but can begin collecting anytime before October 2, 2017.

Performance data must be submitted by March 31, 2018, regardless of when collection started. The first payment adjustments based upon your performance reporting goes into effect January 1, 2019. Depending on the level of participation in the Quality Payment Program chosen and the data submitted, a provider’s 2019 Medicare payments will be adjusted up, down, or not at all. No participation or data submission will result in a 4% negative payment adjustment. If the bare minimum is submitted (one quality measure), there will be a zero payment adjustment. If 90 days of your 2017 data are submitted, there will be a slightly positive payment adjustment, and if a full year of 2017 data is submitted, there will be a moderately positive adjustment in your 2019 payments.

In case you are waiting on collecting your quality data until the outcome of the healthcare reform debate has materialized, MACRA is not likely to go away with a new healthcare bill that addresses the Affordable Care Act (ACA) of 2010. Unlike the ACA or the healthcare bills proposed in 2017 (all along political party lines), MACRA was passed with bipartisan support and was designed to be a cost-saving program that helps preserve Medicare funding into the future. Therefore, SCA’s Economics and Governmental Affairs Committee, chaired by Gordon Morewood, has taken on the responsibility of educating our members regarding issues such as MACRA and compensation models (see the June 2017 SCA Bulletin).

Coordinating efforts with our Safety and Quality and Continuous Practice Improvement subcommittees, the committee will help our membership navigate through these changing times. Educational panels were offered during the 2017 SCA Annual Meeting, and are in the planning stages for the 2018 meeting, in addition to the information provided in the SCA Bulletin.

Another benefit that SCA has provided for our membership is the opportunity to participate in the Anesthesia Module of the STS database. The number of anesthesiology groups participating in the STS Anesthesia Database is growing, thus providing a great repository of data that allows comparison and benchmarking with other groups that practice cardiac anesthesia. If your group is not yet participating, I strongly encourage you to consider joining this repository of data that provides reports in aggregate to member groups. We have previously described the rationale and benefits to joining the Anesthesia Module to the STS database in an article published in Anesthesia & Analgesia1, and information for joining the Anesthesia Module of the STS is found on the STS website.

As mentioned in my first message as your SCA President, I really want to hear from you on how we can make your Society better in serving your needs. I also would like to learn how best we can utilize our new website and all of our educational venues to enhance your ability to take better care of your patients and help you meet your practice needs for cardiac anesthesia. We have established a special way for you to share your input and ideas regarding the Society. Please send your ideas and feedback with a “Contact Chris” note to help our Society better serve you and our patients at I thank you in advance and look forward to hearing from you!

Chris Troianos, MD
SCA President

  1. Aronson S, Mathew J, Cheung A, Shore-Lesserson L, Troianos C, Reeves S. The rationale and development of an adult cardiac anesthesia module to supplement the Society of Thoracic Surgeons National Database: using data to drive quality. Anesth Analg. 2014;118:925-932.

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