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What Will Happen to MACRA Under a Trump Administration?

by Jackie Lichwell, RN, BSN, MSHMI , Senior Manager, Quality Performance

Tuesday’s election outcome has healthcare providers, patients, vendors, and industry observers wondering what’s in store for healthcare—not just for the Affordable Care Act, which President-elect Trump has threatened to repeal, but also federal mandates steering payment transformation and the transition to value-based care. Will the gas be turned off, or just dialed back?  Will the majority Republican administration turn to different, market-based reforms to ease utilization and control costs?

There is general agreement that the shift from fee-for-service to value-based care will continue, but the pace remains in question. There is a high likelihood that some of the Obama Administration-driven demonstration projects of value-based care approaches may be scaled back. The Center for Medicare & Medicaid Innovation may cede some of its hand in payment reform initiatives to Congress, which would take on an increased role in driving new regulations and programs. Briefly put, a Trump administration offers an unknown future for value-based care—and for health IT. 

That’s cold comfort for the millions of providers who have MACRA on the brain and are planning massive reallocations of time, money, and resources to prepare for the rule’s implementation in 2017.

Here is what we do know:

There are no immediate indications MACRA will be repealed.  

The Affordable Care Act and MACRA are separate.  The ACA is a US healthcare reform law with a focus on providing more access and reducing spending. MACRA is a bipartisan federal legislation signed into law in April 2015 that established a new way to reimburse clinicians caring for Medicare beneficiaries and lays the groundwork to transition from a fee for service world to a value based payment system. A repeal of the ACA would not, therefore, be a repeal of MACRA.

Providers should move forward with the expectation that MACRA will continue.  

Providers should continue to prepare for MACRA’s Quality Payment Program and its two tracks. It’s in the majority’s best interest to prepare for MIPS, which we know isn’t going anywhere, and for which many more clinicians are eligible.  Providers should participate in Meaningful Use and PQRS today, if they’re not already, to familiarize themselves with the requirements to participate in MIPS in 2017.



Though it’s too early to know for sure what the next administration will bring, we have no reason to expect MACRA to go away.  Familiarize yourself with the five things all providers need to know about MACRA, and stay the course.  At athenahealth, we want our providers to be successful under any payment model because our revenue is at stake, just like theirs. athenahealth will be here working to understand our shifting landscape, and optimizing athenahealth practices for success under any scenario.

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