JACC's Walsh: MACRA means working smarter, more efficiently

MACRA—the Medicare Access and CHIP Reauthorization Act of 2015—will have profound impact on the healthcare industry as a whole. In the Aug. 14 “Leadership Page” of the Journal of the American College of Cardiology, ACC President Mary Norine Walsh, MD, details her views on just how cardiologists and practice administrators can prepare themselves.

The move from a volume-based system to one more focused on value will change how cardiologists see patients.

“Our current fee-for-service payment model has probably driven some of the office visit volumes and frequency, and tradition has had an influence as well,” Walsh wrote. “An annual visit to a cardiologist for a patient with cardiovascular disease may be the norm in some communities, but there is regional variation in visit frequency. The emergence of newer payment models, in particular, accountable care organizations (ACOs), in which health systems assume a share of financial risk for patient costs, presents a new impetus to examine this question from an individual and a population health management perspective.”

The industry must consider how practices will need to change in response to MACRA—and how these changes should be made. Walsh lists five critical tenants for transformation: team-based coordinated care, expanded access, transitional care planning, preventative outreach and behavioral healthcare coordination.

In a more integrated system of care, cardiologists will ideally see more sick patients instead of stable ones. Cardiologists will be focused on examining new patients with complex symptoms to develop a personalized plan of care.

“With practice transformation, we will need to work smarter,” Walsh wrote. “Systems of care that involve fewer in-person visits, but continue to keep our patients engaged will be necessary. Systems of open-access scheduling, telehealth, navigator models, access through patient portals, and group visits will all be models of care that we need to explore and embrace.”

The full leadership letter is available online here.