Consultants at Optum say yes. Specifically they say hospitals and health systems should prepare for changes to referral patterns and readmission rates.
Jay Hazelrigs, vice president and lead actuary at Optum, ties referral issues to consolidation.
He says there’s the chance MACRA will offer a reason for providers to consolidate on their own. That could mark a change since hospitals and health systems typically play the role of consolidators.
“In a competitive market, where physicians—especially primary care physicians—begin to merge with one health system, the systems on the outside looking in could become more exposed to referral loss,” says Hazelrigs.
Julie Witt, director of actuarial consulting, says MACRA gives hospitals another reason to think about lower admission rates.
“MACRA metrics focus on reducing unnecessary hospitalizations,” says Witt. “As physicians gain efficiencies to meet the MACRA requirements, this will trickle down to reducing admissions, which will increase pressure on hospitals to transform to a value-focused care delivery model.”
You’ll read about the capabilities hospitals need to be good resources for doctors and opportunities to benefit from physician collaboration. You’ll also read about the role hospitals can play for physicians participating in the Merit-based Incentive Payment System (MIPS).
About the Author:
VP for Health Management Consulting
Erik is a VP for Health Management Consulting. He has broad experience in designing population health strategies for a broad array of providers. He was most recently Senior Vice President at Avalere Health, where he ran its Healthcare Networks consulting practice and oversaw new product development. Erik assisted healthcare systems in determining how to adopt and assess accountable care and bundled payment models, and guiding overall strategy. Erik also worked with health IT companies in responding to emergent issues around EHRs and data exchange.
Erik has an BA with honors and distinction from Stanford University and an MBA from the Stanford Graduate School of Business.