Question

The Patient Protection and Affordable Care Act of 2010 (ACA) and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the way that healthcare providers are reimbursed in the United States. Both laws attempt to move from a volume-based reimbursement method to a quality-based reimbursement method. For this discussion forum, select one of the two laws and discuss some key points of how the law you selected has changed reimbursement. Consider discussing if we have seen improvements in quality and decreased costs in healthcare since the implementation of the laws.

HC

Answer 1

MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 (MACRA)

The MACRA of 2015 is a bipartisan legislation signed into law on April 16, 2015 set to change reimbursement for clinicians who receive Medicare part B payments. MACRA created the Quality Payment Program that:

• repeals the SUSTAINABLE GROWTH RATE formula
• Changes the way that Medicare rewards clinicians for value over volume
• Streamlined multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
• Gives bonus payments for participation in eligible alternative payment models (APMs)

with the passage of MACRA, there is now a unique opportunity to have Physician & society input into the development of APMs & quality measures that are relevant to critical care & specific patient populations in ICU. The development of MIPs performance measures specific to critical care would be an excellent advance within this new framework. MACRA is designed to help providers report data on the quality of services. The 5 important things to be kept in mind are:

• MACRA includes a quality payment program
• Many healthcare providers will work with a merit based incentive payment system
• Doctor's stand to benefit from alternative payment models
• Exemptions from MIPs participation
• MACRA is funded to provide technical support.

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