Thursday, September 21, 2017

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Without a doubt, the healthcare system in the United States has remained in the media spotlight ever since the approval and implementation of the ACA, also known as the Affordable Care Act or Obamacare. While this piece of legislation delivered much-needed healthcare to millions of Americans who previously didn’t have any, it didn’t do much to eliminate the fee-for-service model of physician compensation that many legislators and patients agreed needed to be changed significantly. For those who don’t know, the fee-for-service model compensated physicians based purely on the number of patients they saw and the services that they provided. While this sounds fair on the surface, many patients and legislators wanted to see physicians compensated for not only the services they provided but also the quality of the healthcare their patients received.

The Introduction of Quality Measures

What resulted was MACRA, also known as the Medicare Access and CHIP Reauthorization Act. This act repealed the dysfunctional Sustainable Growth Formula (SGR) that many physicians despised so badly that they refused to see patients with Medicare. What replaced the SGR was MACRA. MACRA contains a handful of quality measures that will have a significant impact on how physicians are reimbursed for the services that they provide. It is important for patients and physicians to understand these quality measures and how they will impact patient access to healthcare, the cost of healthcare, and physician reimbursement for their services.

Quality

The first section of the MACRA quality measures refers to the quality of patient care and patient outcomes. This section will impact physician reimbursement rates the most. For example, physician practices could be judged based on the percentage of their patients who successfully quit smoking, the percentage of patients with diabetes who maintain an acceptable hemoglobin A1c score, or the readmission rates of patients after discharge. For physicians who saw patients on Medicare under the old system, this will represent a major shift in how patient care is compensated

Resource Use

The second category of MACRA quality measures is called the resource use section. As part of this reimbursement factor, physician practices will be judged based on how judiciously they use the resources of the healthcare system when they see Medicare patients. For example, are patients receiving diagnostic tests or treatments that they don’t need? Or are physician practices working hard to limit healthcare dollars that are spent on patients? While some scans and tests may be necessary, this section will encourage physicians to think carefully about how and when to order expensive tests and treatments.

Clinical Practice Improvement Activities

The third category of the MACRA quality measures is called the clinical practice improvement activities. In this section, physician practices will be encouraged to complete different activities to improve their practice. For each activity they complete, the practice will receive a certain number of points. For practices that reach a certain number of points, they will receive a performance bonus from the Medicare system. Examples of activities that practices may decide to complete include improving the access of various patient groups to healthcare, advocating for healthcare equity, and educating patients on the various facets of their illnesses.

Advancing Care Information

The final category of the MACRA quality measures is called advancing care information. This is the section dedicated to improving the communication of various healthcare entities with regards to patients who may see multiple physicians. Most doctors have realized that it can be challenging to obtain healthcare records from separate EMR or hospital network systems. Under this category, doctors will receive bonuses or penalties based on how well their system talks to other practices in the area. Physician practices will be encouraged to make it easier for other doctors to request information on patients that they might see.

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flickr.com/photos/jerikoegel
freedigitalphotos.net/jk1991