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MACRA

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20

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Johanna
Martinez

Carrington
College

 

 

 

 

            To understand MACRA, you must know the Physician Quality
Reporting System, Medicare Access and CHIP Reauthorization Act is and how it’s
processed to determine the Quality Payment Program for physicians.

            MACRA referred to as the “Medicare Access and CHIP
Reauthorization Act”, it was created by Department of Health & Human
Services implemented rules for medical services. MACRA is used by the Centers
for Medicare and Medicaid Services to establish a certain measures to determine
how the physician will be charging Medicare and Medicaid beneficiaries. “MACRA
replaces the 1997 Balanced Budget Act’s SGR that was used to determine annual
physician payment updates” (AMGA, 2016) MACRA proposed a rule called the Quality
Payment Program, it reports quality reporting programs under a single one. The
new program will include one of two paths for eligible clinicians, the
Merit-based Incentive Payment System (MIPs) and Alternative Payment Models
(APMs). “In implementing the new law, we were guided by the same principles
underlying the bipartisan legislation itself: streamlining and strengthening
value and quality-based payments for all physicians; rewarding participation in
Advanced APMs that create the strongest incentives for high-quality,
coordinated, and efficient care; and giving doctors and other clinician’s
flexibility regarding how they participate in the new payment system.”(EHRIntelligence,
Xtelligent Media 2012-2018).

The
payment model designed by CMS to increased plasticity for healthcare providers
with the understanding of quality. Certified EHR used it to report it and to
simplify the reimbursement process for providers.

            The Physician Quality Reporting System is a feature
reporting program that inspires eligible professionals and group practices to
report information on the quality of care to Medicare. The Physician Quality Reporting
System gives participating group practices the opportunity to measure the
quality of care they provide to their patients. They help to ensure that
patients get the right care at the right time by all means by reporting on Physician
Quality Reporting System measures. Individual and Group practices can quantify
on how often they are meeting a particular value metric system.

            A bill signed into law by President Obama April 16, 2015 called
the Medicare Access and CHIP Reauthorization Act. This bill was to help the
U.S. Healthcare reform and to replace the current Medicare reimbursement
schedule by initiating a Pay-for-Performance program. This program focuses on
Quality, Value, and Accountability for each patient. In the past, the physician
would get rewarded on how much care they gave to each patient, now they’re
getting rewarded on giving efficient care for each patient.” MACRA does many
things, but most importantly it establishes new ways to pay physicians for
caring for Medicare beneficiaries.” (2018 Network for Regional Healthcare Improvement)

            There are certain criteria that a physician must meet
under the Merit Based Incentive Payments System, the first being Quality.
Quality measures are tools that help measure health care processes, outcomes,
and the patients perceptions associated to the ability to provide high-quality
health care from their physician and their practice. Centers for Medicare and
Medicaid Services link the outcomes to health care quality goals such as timely
care, efficiency, effective, safe, equitable, time centered and the safeness
for each patient. The Resource Use is similar to Quality, but it compares the
resources used to treat comparable care episodes and clinical condition groups
from an assortment of medical practices. The Clinical Practice Improvement intended
to see how the Group or Practice participates in activities to achieve better
service and how to improve their practice. Meaningful Use of Certified EHR
Technology, is a structure format to store data. It captured and shared patient
data more efficiently, it is an easier process for health care providers to
transfer and retrieve patient information.

            MACRA is used for Medicare Part B payments as of right
now, but implementing MACRA rules about compliance for compensation will
motivate patients for change and reassure broad-based transparency and
accountability for all.

 

           

             

           

References

https://www.amga.org/wcm/MACRA/WIM/wcm/Advocacy/MACRA/macra_lm.aspx

AMGA,
(2016)

     Retrieved from

    
https://www.amga.org/wcm/MACRA/WIM/wcm/Advocacy/MACRA/macra_Im.aspx

https://ehrintelligence.com/news/how-value-based-care-looks-under-the-quality-payment-program

EHRIntelligence,
Xtelligent Media (2012-2018)

     Retrieved from

    
https://ehrintelligence.com/news/how-value-based-care-looks-under-the-quality-payment-program

 

What Is MACRA

Network
for Regional Healthcare Improvement (2018)

     Retrieved from

   

What Is MACRA

 

 

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