The CHIP (Children’s Health Insurance Program) has linked with Medicare and Medicaid to establish a strong foundation for assigning health coverage. This healthcare coverage can account for youngsters in underprivileged-income homes. Healthcare costs in the US are a problem as Americans spend a huge amount of money on healthcare yearly, which increases the cost persistently. The rise is partly due to the policy of the government and the inception of national programs such as Medicare and Medicaid. The essay focuses on defining and reflecting on the importance of why healthcare leaders and professionals should learn and understand the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA). The MACRA of 2015 has accelerated the movement of doctors into corporate employment by healthcare facilities, to some extent by other corporations and health insurers.
Definition of MACRA
The MACRA is bipartisan legislation that was enacted into law on April 16, 2015. It established a quality payment program that changed the way Medicare rewarded clinicians for value over volume and repealed the sustainable growth rate (SGR) formula. In addition, the act streamlined many quality programs under the new Merit-Based Incentive Payment Systems (MIPS) and provided bonus payments for involvement in eligible alternative payment models (APMs) (Casalino, 2017). Further, MACRA demanded the removal of Social Security Numbers (SSNs) from all Medicare Cards by the end of April 2019. Therefore, MACRA is a law that substantially transformed how the Federal government pays healthcare workers. The enacting of this law eternally repealed the faulted SGR and established the two-track Quality Payment Program (QPP), which centered on value-based payment models. The federal government passed the MACRA in 2015 to resolve the rising costs of Medicare (Lee, 2017). The policymakers were keen to replace conventional fee-for-service that rewarded healthcare providers for the volume of services with value-based compensation.
Importance of Healthcare Leaders and Professionals’ Learning and Understanding MACRA
Consequently, learning and understanding MACRA needs a brief deviation for healthcare leaders and professionals. All patients experience the unfortunate disease risk, leading to the main financial risk because of the high healthcare costs. Insurance decreases the risk by reimbursing for expensive care if it becomes necessary. The reimbursements are funded either by premiums in the case of private healthcare insurance coverage or government borrowing and taxes in the case of public healthcare coverage insurance such as Medicare (Freedman, 2022). This leads to taxpayers and patients ending up bearing the burden of escalated healthcare costs.
Under the conventional fee-for-service framework, the financial risk of high healthcare costs falls on insurers; therefore, taxpayers and patients. It contributed to healthcare providers experiencing little to no financial risk, as they are typically reimbursed at or above the marginal cost for every service offered. The system was rewarding quantity over quality; thus, healthcare providers have a robust incentive to over-treat patients and, at times, offer health services with harm or little tangible benefit. Fee for healthcare service payment for injectable medications contributed to erythropoietin overuse in dialysis (Lin, MaCurdy, & Bhattacharya, 2017). This was after a study revealing that much erythropoietin in dialysis harms patients; healthcare providers continued to target inappropriately high hemoglobin levels in surplus of contemporary direction recommendations. Both the Federal government and Medical Payment Advisory Commission noted that bundling payments could temper the overuse and increase costs (Squitieri & Chung, 2017). Since the prospective payment system bundled injectable treatments into a single dialysis reimbursement, there witnessed a decline in the use of erythropoietin and a subsequent decline in death, heart attacks, and strokes.
Further, healthcare leaders and professionals should learn and understand that the effect of MACRA will fundamentally change the way care and services are reimbursed and evaluated. MACRA performs many aspects even though, most significantly, it develops new means of paying physicians for caring for Medicare beneficiaries. The law comprises new financing for technical help to providers, financing for measure improvement, and testing. It supports new requirements and programs for data sharing and develops new federal advisory groups (Freedman, 2022). MACRA initiated the MIPS payment system for which healthcare provider’s practice will have to register and file data when a physician’s practice attains some standards.
Moreover, the MIP program may generate higher compensations for healthcare providers’ practice when they offer better care. On the other hand, lower-quality care may result in lower compensation. Whether healthcare providers qualify relies on their billing volume, clinical type, and other aspects. Some eligible healthcare practitioners are not needed to participate, while engagement is compulsory for others. MACRA transformed how healthcare practices are paid when they offer care to Medicare beneficiaries (Squitieri & Chung, 2017). It moved Medicare healthcare providers from a conventional fee-for-service structure to a more progressive value-based healthcare practice. Healthcare providers will growingly be reimbursed based on the results of their care. Hence, this model offers a chance to choose and utilize clearer and more meaningful, and manageable measures that can enhance reporting effectiveness and accuracy and minimize wastage. However, the push of MACRA for value-based reimbursement can have an additional effect beyond payment change and measurement (Lin, MaCurdy, & Bhattacharya, 2017). Since healthcare practitioners will be reimbursed according to patient results, they should understand and learn about what transpires across the system outside of their offices.
References
Casalino, L. P. (2017). The Medicare Access And CHIP Reauthorization Act And The Corporate Transformation Of American Medicine. Health Affairs, 36(5), 313-328. Web.
Freedman, M. (2022). Understanding MACRA and MIPS – businessnewsdaily.com. Web.
Lee, K. (2017). What is MACRA (Medicare access and CHIP Reauthorization Act of 2015)? – Definition from WhatIs.com. Web.
Lin, E., MaCurdy, T., & Bhattacharya, J. (2017). The Medicare Access and CHIP Reauthorization Act: Implications for Nephrology. Journal of the American Society of Nephrology, 28(9), 2590–2596.
Squitieri, L., & Chung, K. C. (2017). Value-Based Payment Reform and the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: A Primer for Plastic Surgeons. Journal of the American Society of Plastic Surgeons, 140(1), 205–214.