Identify Provider and Two Changes - MACRA and Physicians

Running head: ACA COURSE PROJECT INTRODUCTION

ACA COURSE PROJECT INTRODUCTION

Introduction: The ACA, Physicians, and MACRA

Hannah Warner

Rasmussen College

Author Note

This paper is being submitted on October 19, 2016, for Kristi Downs' H360 Healthcare Planning and Policy Management course.

Introduction: The ACA, Physicians, and MACRA

For this work, I will focus on the changes made by the Affordable Care Act (ACA) in 2010 which directly affect physicians; specifically, those who work for Medicare reimbursements. The Medicare Access and CHIP Reauthorization Act in 2015 (MACRA) essentially shifted the focus of the physician to perform with the highest quality of service deliverable if they wish to receive Medicare payments. Under the law, there are two new payment systems from which the provider can choose: (1) the modified fee-for-service model called the Merit-based Incentive Payment System (MIPS) or, (2) an advanced alternative payment model (APM), in which physicians participating in payment models specifically approved by the Centers for Medicare & Medicaid Services (CMS) can receive an annual bonus payment (Key Issues, n.d.). The MIPS payment system requires quality measurement of key areas and consistent reporting of quality outcomes, all to be reported by the physicians themselves. This process may or may not affect the physician's daily workflow, considering reporting of data happens in many different ways: through direct Medicare claims, through the practice’s online EHR at the time of appointment, or through the Medicare Physician Quality Reporting System (PQRS) online portal.

The second change affecting physicians is the Centers for Medicare and Medicaid Services’ launch of the Physician Compare website, which allows patients to post reviews and "grade" reports regarding a physician’s quality of service, pricing, or other issues with the doctor's office. Since PQRS data captured by the quality measures is already required to be reported for Medicare reimbursement, it only stands to reason that this data will be a factor on the CMS Physician Compare website. Therefore, by utilization theory alone, this combination serves as an incentive/penalty program for physicians that uses performance-based PQRS data, translates it into measurements of quality, and reports it for public use to make an informed decision about options for medical care. This program is a requirement under the ACA which significantly – though, ethically - affects Medicare reimbursements for physicians (American Medical Association, 2016).

References

American Medical Association. (2016). Advocacy MACRA Action Kit [PDF]. Retrieved from

file:///home/chronos/u-ecf1cd7ebd833fe3d26506a372bc264b21bb8777/Downloads/16-0384-advocacy-macra-action-kit.pdf

Key Issues. (n.d.) AONE. Retrieved from

http://advocacy.aone.org/key-issues/macra-quality-payment-program

Paige, L. (2013). 8 Ways That the ACA is Affecting Doctors' Incomes. Recruiting Physicians Today. Retrieved from

http://www.nejmcareercenter.org/minisites/rpt/8-ways-that-the-aca-is-affecting-doctors-incomes/