Question

1 a) Will IMPACT really have any impact on how skilled nursing is provided in the United States? IMPACT applies to post-acute care organizations that participate in Medicare, so you will need to identify what types of care and facilities the federal law applies to.

1 b) Assume you are the administrator for a group practice. How would you determine if MIPS or APM is best for the physician practice? Thinking about this course, are there specific financial analysis tools that can assist in making this decision, and if so which ones would you use and why?

1 c) MACRA has now been in existence since 2017 and impacts how physicians are paid under Medicare, whether they are independent of a healthcare system or part of a system. It does replace the SGR that was extremely unpopular amongst physicians. Is MACRA successful in encouraging both quality outcomes and cost effectiveness?

Answer 1

1. The Improving Medicare post-acute care transformation Act of 2014 is called as IMPACT act. It was the law that came into enforcement to make sure there is a standardised platform to evaluate the efficacy of the services relating to health care services like quality of service, treatment methods by the PAC (post-acute care) providers. It does have a huge impact on the skills and developing relevant skills to the ones assessed under this law. Following are types of care and facilities this law applies to

· Measuring quality: it includes functional status, changes in cognitive functions, changes in skin integrity, accidents including major falls, medication and its reconciliation communicating healthcare information and medical preferences with transitions.

· Use of resources and measure domains.: it includes total evaluation and estimation of Medicare spent per beneficiary, and includes all the conditions with risk adjustment in order to prevent readmissions to hospital.

· Categories of assessment includes: cognitive, functional, mental, impairment medical conditions and co-morbidities.

2. As an administrator for such group practice, we can determine that MIPS and APM is best for the physician as Both induce quality as both of them provides monetary benefits to them who deliver the exceptional quality of service and merit or value based. So, the focus gets on delivering best service and brining in clinical innovations. The financial tool used for decision making is CMS. It is calculated by four measure to determine final score which finally determines the payment to be adjusted viz quality of service, promoting interoperability, cost and activities of improvement. This is very important as it takes into account the cost reduction part too, to make it right delivering best quality at best price.

3. MACRA i.e. Medicare access and CHIP reauthorisation Act, which was reinforced in the year 2015 created the quality payment program that focuses on quality, value and accountability. MACRA got in MIPS which measure quality in four performance categories. And final score is calculated based on which the payment is made. As it replaces SGR, MACRA is quite popular among physicians and is quite successful in encouraging both quality and cost effectiveness. Both being the important categories of evaluation for the final performance score.