6051 WK 11 5/3 Assignment: Policy/Regulation Fact Sheet
The Quality Payment Program is an incentive policy established by the Medicare Access and CHIP Reauthorization Act (MACRA). The program rewards the eligible clinicians and physicians through either the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs) (HealthIT.gov, n.d.). Fundamentally, MACRA helps the providers transition from traditional fee- for- service (FFS) to a more stable value-based payment system (O’Shea, 2017).
Implementing MACRA streamlines the physician practices’ administration and financial reporting burden. The previous health care performance reporting requirements; the Physician Quality Reporting System, the Value-based Payment Modifier, and the Meaningful Use are combined into MIPS (O’Shea, 2017). Moreover, MACRA also impacts other professionals like therapists, clinical psychologists, and social workers (Oshiro, 2019). Therefore, regulations involve the medicare and Medicaid patients; however, due to system implementation of MACRA, programs like the private insurance in the health care industry will emerge.
MACRA legislation contributes to the CMS quality strategies and effort to improve the healthcare delivery. Incentives that build on value payments are employed to improve coordination in healthcare settings, healthcare delivery, and fully utilize healthcare data (Norris, 2016). MIPS has added patient engagements and coordination to emphasize patient-centered care. Consequently, data sharing among physician practices improve the quality of care and reduces the overhead spending (Hussey et al., 2017).
- Health care organizations should understand the requirements of the Quality Payment Program as a preparation for the implementation of MACRA.
- Providers should internalize the MIPS and APMs requirements (Eastman, 2017).
- The organization should develop a value-based strategy that addresses the hospital’s trajectory.
- The hospital should also consider to support of the independent clinicians in the community and the affiliated network (Rappleye, 2017).
- The organization should measure the readiness of the physicians to align themselves with the market’s value-based care.
- While involving the employees, the hospital’s policymakers should thus choose either to adopt the MIPS or APM options.
- Healthcare organization should get started on the MACRA strategy.
References
Eastman, P. (2017). CMS proposes rules on implementing quality payment program under MACRA. Oncology Times, 39(15), 24-25. https://doi.org/10.1097/01.cot.0000524343.65477.e3
HealthIT.gov. (n.d.). Health IT legislation. Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/topic/laws-regulation-and-policy/health-it-legislation
Hussey, P. S., Liu, J. L., & White, C. (2017). The Medicare Access and CHIP Reauthorization Act: Effects on Medicare payment policy and spending. Health Affairs, 36(4), 697-705. https://doi.org/10.1377/hlthaff.2016.0559
Norris, S. (2016, November). MACRA’S impact on patient engagement and care coordination. InfoMC. https://www.infomc.com/images/news/MACRA_Care%20Coordination_112116_tDxk.pdf
O’Shea, J. (2017, April 21). As MACRA implementation proceeds, changes are needed. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20170421.059725/full/
Oshiro, B. (2019, April 15). Physicians must prep for the financial impact of MACRA. Health Catalyst. https://www.healthcatalyst.com/physicians-must-prep-for-the-financial-impact-of-macra
Rappleye, E. (2017, March 7). 5 steps to get your hospital’s MACRA strategy off and running. Becker’s Hospital Review. https://www.beckershospitalreview.com/finance/5-steps-to-get-your-hospital-s-macra-strategy-off-and-running.html
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