Tuesday, March 21, 2017

MACRA: Quality and Cost in Healthcare

For some time now, the US healthcare system has been moving from a fee-for-service system to a pay for quality-of-service system. In the past, healthcare providers were paid for the number of services they provided. And now, more and more, providers are being encouraged to expect to be paid based on quality and cost. Providers are encouraged to reduce healthcare costs and improve patient outcomes. The Medicare Access and Chip Rauthorization Act (MACRA) is furthering that encouragement.

Over the past eight years or so, three important government actions have been taken. These actions are as follows: The establishment of The Electronic Health Record Incentive Program, the passing of the Patient Protection and Affordable Care Act (ACA), and the passing of the Medicare Access and Chip Rauthorization Act (MACRA).

The Electronic Health Record (EHR) Incentive Program was put in place in 2009. This program required that healthcare providers collect patient health information and record the information in an EHR. The main purpose of EHRs is to allow patient information to easily flow between the different types of healthcare providers. EHRs also give patients easy access to their health records. And the government wants providers to make meaningful use of EHRs. In fact, the EHR Incentive Program is sometimes called the meaningful use program.

The ACA was enacted in 2010. The purpose of the law was to expand healthcare coverage for more Americans, lower healthcare costs, and improve the quality of patient care. One of the ACA's purposes was to enable a patient to get more value for his or her healthcare dollar.

MACRA was passed in 2015. It was established to further the goals of the ACA. An important part of MACRA is the Quality Payment Program or QPP. QPP is a refinement of existing quality and cost programs. The purpose of QPP is to help move healthcare from a fee-for-service payment system to a pay-for-value system. There are two avenues from which eligible healthcare providers can choose to take part in QPP. One avenue is by way of the Merit-based Incentive System (MIPS) and the other avenue is by way of Advanced Alternative Payment Models (APMs).

Both MIPS and APMs emphasize improvement in healthcare quality and reduction of healthcare cost. And, again, providers can choose one of these programs as their reimbursement method.

Healthcare providers, including those offering obesity medicine services, should work to establish objectives within their practices that enable the practices to accommodate quality and cost measuring programs like QPP. Even with potential changes in the American healthcare system, quality and cost measuring programs will likely be a part of any future healthcare system.


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