Collaborative Care in the MACRA Era


Providers with a limited practice scope should be prepared to participate in collaborative care or reimbursement under MACRA could suffer, Dr. Edward Lin says.

For obese patients with knee and hip osteoarthritis, bariatric surgery is frequently considered to improve symptoms. Bariatric surgery is considered by some industry experts an example of how physicians can fulfill the purpose of the Medicare Access & CHIP Reauthorization Act (MACRA) 2015. The legislation is designed to improve healthcare services while lowering costs and by 2019, the Centers for Medicare & Medicaid Services anticipates MACRA will move most physicians into the pay-for-performance arena. That shift makes reimbursement dependent on the quality of care they provide. As an initiative, MACRA has been highly popular, garnering overwhelming support in both Houses of Congress. The House voted 392-to-37 in favor of the Act, and the Senate voted 92-to-8. According to an editorial published in Bariatric Surgical Practice and Patient Care and written by Emory University School of Medicine’s Edward Lin, D.O., the goal is to change healthcare delivery methods so they can increase access, reduce the number of steps before care is provided, and offer greater, more coordinated comprehensive services. These changes, Lin wrote, could mean providers with a limited practice scope suddenly find themselves thrust into unforeseen and unexpected clinical situations. They should still do their best, though, to participate in collaborative care. If they don’t, their reimbursement will suffer. Based on MACRA data, physicians who opt to ignore the call for collaboration will receive a 4 percent reimbursement penalty in 2019, a 5 percent penalty in 2020, and a 9 percent penalty after 2022. For surgeons interested in preparing, Lin recommends they stay up-to-date on the fundamentals of healthcare. And, the procedure best suited to demonstrate this is bariatric surgery, he said. “As for rheumatology,” Lin said. “I believe access to consults - both inpatient and outpatient - and pairing with strong primary care providers is key.” Bariatric surgery teams are particularly well suited, he said, because they are largely in-house. They provide nonsurgical weight loss treatments, such as medications and medically supervised diets, and presurgical evaluations that include assessments and treatment coordination for obstructive sleep apnea and cardiac risk assessment. They also prescribe micronutrient supplementations that affect healing, such as Vitamin D, and initiate treatment for newly discovered A1C elevations. This type of system, Lin said, offers patients a veritable medical home - one that offers a lifetime of comprehensive, coordinated care. It fills in any gaps in care a patient might otherwise experience with long waits, inferior information transfer between providers, and a silo approach to providing care that allows providers to collect fees individually for services.   


Lin Edward. “Bariatric Surgery and MACRA Legislation,” Bariatric Surgical Practice and Patient Care. June 2016, Vol. 11, No. 2: 37-38


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