DQ2. MACRA – Opportunities and Challenges - Analyze the new MACRA requirements in terms of the opportunities and challenges for HCOs as they work to comply. What are the positive/negative impacts and issues that arise? What do you think will be the most difficult challenge going forward? How can HCOs realize benefits from the MACRA mandate? Support your claims with evidence or examples.
The enactment of the MACRA program will have a significant impact on the future direction and structure of health care regardless of the type of practice is in place, whether hospital based or private practice. MACRA, otherwise known as the Medicare Access and CHIP Reauthorization Act of 2015, implemented the clinician payment reforms known as the Quality
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One of the positive impact is that it stresses the improved use of technology specially with interoperability. MIPS encourages health information exchange and patient engagement (e.g. patient portals) while recognizing the importance of gathering, analyzing, and sharing key patient data as crucial to improving patient outcomes and lowering overall costs (Pottinger, 2017). Another positive impact is that it focuses on improved patient outcomes. Since it is a value-based care reimbursement, the scores accrued help determine bonuses or penalties, incentives that pushes for the improvement of care and the achievement of enhanced patient outcomes (Pottinger, 2017). On the negative side, many HCOs and practitioners feel that MACRA seems to have been implemented relatively fast. HCOs who lack expertise in developing strategies to achieve the highest performance scores had difficulty in addressing performance improvements in both changes in workflow and system requirements (Mandros, 2016). Another negative impact is that MACRA’s quality initiatives tend to favor larger practices with vast resources but generate a liability for smaller practices (Shinkman, 2016). This is because large practices find it easier to join in group reporting registries, which is needed for many MACRA quality measures. This will likely encourage the incorporation or purchase of smaller practices by larger …show more content…
(2017). The Medicare Access And CHIP Reauthorization Act: Effects On Medicare Payment Policy And Spending. Health Affairs, 36(4), 697–705. doi:10.1377/hlthaff.2016.0559
Leventhal, R. (2016, December 29). OIG Identifies Vulnerabilities in CMS’ Deployment of MACRA. Retrieved from https://www.healthcare-informatics.com/news-item/payment/oig-identifies-vulnerabilities-cms-deployment-macra
Mandros, A. (2016, June 20). MACRA – Who Are The Winners & Losers? . Retrieved from https://www.openminds.com/market-intelligence/executive-briefings/macra-what-is-it-how-does-it-affect-you/
Pottinger, L. (2017, November 28). MACRA: Understanding its Current and Future Impact. Retrieved from
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Connecting and teaming up with other community interested parties allows the organization to support the financial and quality goals, and coordinate care across the board giving more efficient and quality care (McKesson, 2018). This could help bring occupancy and admission levels up along with maximizing technology’s value by connecting the dots to help reduce complexities and cost. As regulatory, financial, clinical and consumer pressures influence healthcare organizations to produce and provide more effective and efficient care, healthcare technology becomes even more
The federal government has taken a stance to standardized care by creating incentive programs that are mandated under the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009. This act encourages healthcare providers and healthcare institutions to adopt Meaningful use in order to receive incentives from Medicare and Medicaid. Meaningful use is the adoption of a certified health record system that acquires or obtains specified objectives about a patient. The objectives or measures are considered gold standard practices with the EHR system. Examples of the measures include data entry of vital signs, demographics, allergies, entering medical orders, providing patients with electronic copies of their records, and many more pertinent information regarding the patient (Friedman et al, 2013, p.1560).
There are three steps that are needed to document soft returns: Identifying a process improvement opportunity, create a formula to calculate the benefits, and determine the costs of the process and the net benefits. Besides the three steps, there are various benefits for implementing EHR, such as improving the safety, quality, effectiveness and efficiency of care to meet patients ' expectations (satisfaction). In other words, the contribution of EHR in health systems can enhance organizations ' performance (Smith, 2009).
Meaningful Use and the EHR Many new technologies are being used in health organizations across the nation, which are being utilized to help improve the quality of health care. Electronic Health Records (EHRs) play a critical role in improving access, quality and efficiency of healthcare ("Electronic health records," 2014). In order to assist in expanding the use of EHR’s, in 2011 the Centers for Medicaid and Medicare Services (CMS), instituted an EHR incentive program called the Meaningful Use Program. This program was instituted to encourage and expand the use of the HER, by providing health professionals and health organizations yearly incentive payments when they demonstrate meaningful use of the EHR ("Medicare and Medicaid," 2014).
Holahan, J. (2012). The cost and coverage implications of the ACA Medicaid expansion: National and state-by-state analysis. Retrieved from urban.org
Healthcare in the U.S. has recently been affected by implementation of the Affordable Care Act (ACA) of 2010. The intent is to create a healthca...
Healthcare has been a topic of discussion with the majority of the country. Issues with insurance coverage, rising costs, limited options to gain coverage, and the quality of healthcare have become concerns for law makers, healthcare providers and the general public. Some of those concerns were alleviated with the passing of the Affordable Care Act, but new concerns have developed with problems that have occurred in the implementation of the new law. The main concerns of the country are if the Affordable Care Act will be able to overcome the issues that plagued the old healthcare system, the cost of the program, and how will the new law affect the quality of the health delivery system.
The Consequences Of Obamacare [Electronic Resource] : Impact On Medicaid And State Health Care Reform : Hearing Before The Committee On Energy And Commerce, House Of Representatives, One Hundred Twelfth Congress, First Session, March 1, 2011. n.p.: Washington : U.S. G.P.O., 2011., 2011. Louisiana State University. Web. 18 Apr. 2014.
Legislation that supports the establishment of Accountable Care Organizations (ACOs, 2009) was recently enacted into law as part of the Patient Protection and Affordable Care Act, and in 2012 the Centers for Medicare and Medicaid Services will begin contracting with the ACOs (Matthew et al., 2011 pp. 669). The.... ... middle of paper ... ... RN, 72(3), 38-41.
Since the initiation of the Affordable Care Act in 2010, Americans have been put back in charge of their individual health care. Under this new law, a health insurance marketplace provides a haven for individuals without insurance to gain coverage. Just this year, citizens found out early whether they qualified for Medicare or the CHIP formally known as the Children’s Health Insurance Program. So much is to be learned about the Affordable Care act and this paper provides the roles of the different governmental branches, along with other important factors associated with this law.
This paper will take into account the Affordable Care Act (ACA) Law and how all three branches of government are involved with the creation and analyze issues associated with the ACA. Subsequently the paper will describe the role of public opinion and lobbying groups. Thirdly this paper will evaluate the concepts of equity, efficiency, and effectiveness showcasing their role in the law and its passage. This paper will take into consideration the anticipated effects on cost, quality, and access, including discussing the balance of markets and the government. In closing this paper will highlight the anticipated effects on Medicare and aging as well as Medicaid and the poor. The ACA was signed on March 23, 2010 with the intention to offer all U.S. Citizens and residents a qualifying health care coverage plan. The law’s focus is to expand coverage, control health care cost, and improve health care delivery system.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
Management; The New Competitive Landscape. Chapter 4, Managing, [University of PhoenixE-Book]. ISBN: 0072538651. Retrieved October 20, 2005, from University of Phoenix EResource, MGT/330-Theory, Practice, and Application, Web site: https://ecampus.phoenix.edu/secure/resource/resource.asp