Financial Impact of MACRA

Looking at the 2018 calendar and working on a couple of presentations for the EPI Conference I decided to shift gears and calculate the financial impact of MACRA.

This decision to look into the MACRA’s financial impact was not a sudden impulse but the consequence of a concern I have. After analyzing last year’s findings from the HIPAA Security Risk Analysis, I was worried that eligible clinicians and support personnel are still not ready for MACRA. Perhaps it is because they don’t think is necessary to do them every year. Potentially they don’t know that this is a legal requirement and the penalties could cost them more than if they practice without a license. Worst of all, they may not realize that failure to do a HIPAA Security Risk Analysis will result in the Practice’s score been penalized under MACRA.  Regardless, what I found was that most Practices still know very little about MACRA and that they are not even aware how much this failure to act will cost them.

Based on the above we decided to gather some information that could be used as a guide for healthcare professionals. There are quite a lot of variables, so these are the assumptions we made based on the data available:

  • Primary Care Providers generate an average of $60,000/month in revenues.
  • Specialists generate an average of $100,000/month in revenues.
  • Medicare patient population of eligible clinicians’ in Florida averages 60% of the total patient population.

In addition to the above-mentioned assumptions we used the following CMS information as guidance:

  • No data Submission: negative payment adjustment of 4%
  • One patient, one measure: no adjustment
  • 90 consecutive days of data: potential positive adjustment
  • 1 year of data: positive adjustment and bonus

Of course, there is more to this as it is not only the reporting but the categories and points for each measure. However, in a simplistic kind of assessment, the financial impact of MACRA for eligible clinicians that opt to do nothing is an estimated loss of $38,000 per year for each primary care provider and $64,000 per year for each specialist in their organization.

At this point in time we are late to change any data for 2017 but we can still prevent some losses if the available information is organized and reported prior to Mar 31, 2018. We also can start working on the measures for 2020 as the more we collect and report the better we will be for when reporting time comes.

This topic is so important that we at Taino Consultants are currently diverting resources to assist healthcare professionals and organizations with MACRA data collection and reporting. We understand there is a lot to process which is the reason we recommend attendance at conferences such as the Compliance and Healthcare Innovation Conference sponsored by EPI Compliance.

There is a lot to do and failure is not an option for which we strongly recommend every healthcare professionals to be proactive, assign resources to ensure everything is taken care of try to submit as much data as possible.