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Why value-based care reimbursement, MACRA are here to stay

vera gruessner | healthpayer intelligence | 5 December 2016 

To read the full article in HealthPayer Intelligence, click here.

The outcome of the presidential election has led to some uncertainty throughout the healthcare industry when it comes to legislative changes and medical coverage. However, providers and payers will need to keep a clear head in the coming months and remember which legislative achievements and healthcare reforms will likely be here to stay for years to come. For instance, the overall trajectory of the healthcare industry has been moving toward value-based care reimbursement in order to cut rising medical spending.

One example of a major piece of legislation that is likely to remain is MACRA and its Quality Payment Program. With the Centers for Medicare & Medicaid Services (CMS) determined to transition to value-based care reimbursement, MACRA legislation has received bipartisan support and is likely here to stay. Hospitals and other medical facilities are unlikely to experience any uncertainty revolving around revenue due to MACRA legislative changes.

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Commenting on the topic, John Nicolaou said: “Any changes to MACRA are unlikely.  The movement toward value-based care reimbursement especially MACRA regulations and its Quality Payment Program are unlikely to see any major changes. Private payers have been steadily moving in the direction of the value-based care environment. For example, Humana recently announced that it is serving 63 percent of its membership through value-based care reimbursement contracts.

Since MACRA regulations are supported by both political parties, the legislation is unlikely to be repealed, Forbes reported. Nilesh Chandra of told the news source: “MACRA is here to stay because of its bipartisanship and providers will likely not face any uncertainties regarding reimbursement under MACRA legislation.  

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