What The Medicare Advantage STAR System Can Teach Us About MACRA

I remember the straw that broke the camel’s back.

 

 

I was closing up the last visit of the day two hours after the final patient had hit the door.  I was dog tired, frustrated and smelled really bad.

 

 

That’s when the fortieth colonoscopy reminder of the day popped up on my screen—and I realized it was never, ever going to get better.  Never.

 

 

Like an alcoholic, I had my “moment of clarity.”

 

 

The STAR rating system is that collection of “quality” measures that the government uses to make sure Medicare Advantage insurers are not inappropriately limiting care to save money.

 

 

It’s what drives all the patient satisfaction measures and colonoscopy prompts that you see from your insurer and on your EHR.

 

 

Meet certain metrics, and your insurer gets benefits, including more money.

 

 

 

Some of which may be shared with you.

 

 

 

The system’s been around for ten years.

 

 

 

It’s been so “successful” that Medicare modeled the MACRA system upon it.

 

 

 

And in the coming years, the MACRA system is what will determine how much you’re paid for your labor—no matter what insurance you’re billing.

 

 

 

So what has ten years of the STAR program taught us about MACRA is going to be like?

 

 

 

Fraud.

 

 

 

There’s gonna be a lot of fraud.

 

 

 

MedPAC, the organization that advises Congress on Medicare policy has recently announced that they are going to revamp the STAR rating system.

 

 

 

Why?

 

 

 

Because of rampant fraud.

 

 

 

Submission and manipulation of clinician-submitted data to obtain more revenue

 

 

 

And when payment is based on data submission, thus it will ever be so.

 

 

 

And it’s going to be the same with MACRA metrics.

 

 

 

They’re both complex, ever-changing and associated with significant revenues.

 

 

 

Within three years, we’ll start to see the MACRA qui tam lawsuits and accusations of fraud fly—just like they already have for Medicare Advantage

 

 

 

MACRA is coming.

 

 

 

So you, as a clinician, are going to have to make a decision.

 

 

 

Do you want to spend your time working within such a system?

 

 

Is your calling in life to enter data for subsequent massage to maximize revenue.

 

 

To have your credentials used to provide plausible deniability that a given data set is certifiably accurate?

 

 

If so, then working within the MACRA system will be a boon for you.

 

 

 

If you want to practice medicine, though, you might want to rethink things

 

 

 

Time is all any of us have.

 

 

Use it wisely.

 

 

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