Policy/Regulation Fact Sheet
The legislation I have chosen to focus on is the Medicare Access and CHIP Reauthorization Act of 2015. One of the elements within the policy is Quality Payment Program, which canceled the sustainable growth rate formula, transformed how Medicare remunerate doctors for a value other than volume, and rationalizes several quality programs on merit-based incentives. At the same time, MACRA provides bonus reimbursements for taking part in qualified alternative payment models (Casalino, 2017). The statute is known for the effective changes it brought about with regard to the payment systems for doctors treating Medicare patients. MACRA was considered as the largest level of change in the US health care system after the ACA of 2010 (Sayeed et al., 2017). The passage of MACRA is a result of two years of close collaboration with the Congress on both sides of the floor and a number of stakeholders. The law touches on a large number of areas within the health care spectrum.
The primary provisions of MACRA include:
- change to the way Medicare doctors get their reimbursement
- It advocated for the increase in funding
- And most fundamentally, it led to the extension to the Children’s Health Insurance Program.
The primary purpose of the Quality Payment Program is to promote innovation and flexibility in the delivery of health care for Medicare recipients, consequently improving the quality and outcome for patients and adequately reward providers based on the quality of work they do through merit-based incentive payment (MIPS) as well as alternative payment models (APM) (Casalino, 2017).
The regulations associated with MACRA also address various incentives for using health information technology by physicians and other health care professionals to improve the efficiency and quality of healthcare delivery. MACRA has significant in the quality of care provision. This is because it advocates for the merit-based incentive payment system. Qualified health care professionals who opt to take part in the MIPS will get annual payment decrease or increase based on their performance (Hussey, Liu & White, 2017). Through the MIPS program, a vast majority of providers will qualify, and they will be scored based on:
- Quality including outcome measures and patient experience
- Promotion of interoperability with EHR technology
- Improvement practices like improved access to health care and enhanced patient engagement programs
- The cost of offering health care
The number of incentives or penalties that physicians get in terms of reimbursement will be founded on the performance standards of a person. The significant overhaul in the Medicare payments will have a direct impact on several stakeholders within the healthcare sector, including health systems, providers, and payers (Casalino, 2017). The clinical practice will recognize physicians for activities that significantly contribute to the advancement of patient care, safety, and care coordination. The legislation will likely enable health care providers to adopt alternative payment models and value-based care, moving away from fee-for-service payment models that were used in the past (Casalino, 2017).
In my healthcare organization, the policy the aspect of value-based care will be accorded significant focus. The MIPS will replace previous incentive programs with a combination of a value-based payment program that would assess the performance of every eligible provider, resource use, significant utilization of EHR technology, and improvement of clinical practice. This will help reduce unnecessary procedures and wasteful spending (Sayeed et al., 2017). Providers will focus on quality rather than quantity. The healthcare organization has an initiative of lowering the overall cost of medical care delivery.