What Do The Healthcare Industry And Politics Have On Common?

The Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015 to support and change the way to pay and evaluated the healthcare in the United states (NHRI, 2017). This law mainly helps to pay the health care providers for the Medicare beneficiaries. Similarly, this law also provides the way of new funding for technical assistance, measure development, data sharing and establish a new federal advisory group that mainly help the healthcare providers for their health care service.

The first piece of legislation (one legislation I discussion 2 pieces of that) discuss is section 101 part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a bipartisan legislation signed into law on April 16, 2015. This law was created to replace the current law in that time Medicare reimbursement schedule with, the revolutionary idea of new program supposed directed focus on the quality, value and accountability of the national health care program. The CMS describe MACRA as a modern system new payment framework, supposed rewarded the national health care providers to obtain the better care instead of more service, looking for value over volume. The information’s observed in the interview provides consistent points

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

However, the quality of these services seems to need improvements as better services to patients and proper care for health will impact the revenue cycle and reimbursements. Obama-care supporters are making the false impression that new government rules would promote opposition, control costs, and advance the quality of health care delivered within Medicare. Believing that, implementing this method would concurrently regulate the growth of Medicare costs in a more rational fashion and close the gap of health care we currently have and the health we would have in our future. No matter what department is seeking insurance reimbursement, accurate documentation is required along with proper billing codes to receive timely reimbursement.

Medicare Access and CHIP Reauthorization Act is a bipartisan federal legislation signed on April 16, 2015 amended as title XVII of the social security act to reform the payment methods that Medicare pays to the physicians for the services rendered by creating Quality Payment Program (QPP) which repeals the Sustainable Growth Rate (SGR) formula for Medicare part B payments, reauthorization of the Children’s Health Insurance Program and implements a rewarding system to physicians for value of care rather than on the volume of services by combining the existing physician quality reporting programs under the Quality Payment Program. The main emphasis of MACRA under this Quality

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

The state of California is active in the payment and delivery system reform. Of the 38 million residents in California, more than 15 million receive care through delegated arrangements with provider organizations in the commercial market, or through Medi-Cal (California’s Medicaid program), Healthy Families (California’s implementation of Children’s Health Insurance Program (CHIP)), and Medicare Advantage plans (California Health Care Almanac, 2015). For the past decade, California’s reimbursement has been through shared risk pool, pay-for-performance quality incentive programs, and full and partial capitation (Pegany & Connolly, 2014). Pegany & Connolly (2014) state that under the Accountable Care Collaborative (ACO) programs, providers and hospitals don’t want assume additional risk, and reward does not outweigh the risk and investments costs. To increase the potential and impact of ACA reform, California policymakers should take advantage of the ACA delivery and payment reforms, and do so will require careful attention.

During the current election, healthcare reform has been a rousing topic that has raised a lot of support for the candidates and also concern for their future plans. For healthcare administrators, this is important so they can strategically start planning for the election results because the effects on healthcare will be major and will not be able to happen overnight. Hillary Clinton plans to simply modify the Affordable Care Act and add a public option; while on the other hand, Donald Trump wants to abolish the Affordable Care Act entirely and replace it with a health savings account and a high deductible and high premium driven system (HDHP). Both of these possibilities affect healthcare and the iron triangle, but they affect the triangle in different ways, which is important for healthcare administrators to prepare for.

Throughout history there have been many acts and guidelines created to try and improve quality of care. MACRA falls into this category of an act that tries to enhance the quality of care for patients under Medicare. Harry A. Sultz and Kristina M. Young, the authors of Health Care USA Understanding Its Organization and Delivery, write that quality was defined as “the degree of conformity with preset standards.” (p. 140) The new definition of quality that Harry A. Sultz and Kristina M. Young write characterizes the quality of a provider’s care as the degree to which the care delivered increases the likelihood of desired patient outcomes and reduces the likelihood of undesired outcomes. (p. 144-145) MACRA was signed into law to try and lead to better patient outcomes by paying physicians based on whether their services are successful or not. The new definition focuses on increasing desired patient outcomes and reducing undesired patient outcomes, and this relates to MACRA because MACRA tries to improve patient outcomes and tries to promote more successful treatments. Another relevant, but more specific course concept would be the Accountable Care Organization (ACO) model. Harry A. Sultz and Kristina M. Young write that the ACO payment structure shifts the orientation of patient care from a series of fee-for-service reimbursed interventions toward financial reward for maintaining patients’ health. (p.

Under the Affordable Care Act, traditional fee for service reimbursement will be methodically phased out over time and be replaced by quality of care reimbursement; therefore, the focus of primary care will be shifted from the actual treatment of patients

In the United States, healthcare has been one of the most controversial issue. Everyone needs to see a doctor when they don’t feel well or for routine check-ups. However, the reality is that not everyone could afford to see a doctor regularly to prevent serious illness. As a result, many people have died due to finding out their illness a bit too late because they have waited until the last minute to see a doctor and it was too late for the doctor to do anything about it. The situation could have been different if they were not lacking healthcare coverage. The government has stepped in to fix the issue but the problem persists due to the complexity of the healthcare system and its involvement with the political system. The Democratic and Republican

Health care in the United States (U.S.) is driven by a makeshift of services and financing. Americans access health care services in diverse ways, from private doctors’ offices, to hospitals, and to insurance providers. The effects of the ACA will have numerous changes impacting hospitals and physicians practices. One of the main goals of healthcare reform is to reduce Medicare expenses by combining payment for services provided by hospitals, doctors, and nursing homes into one lump sum, which will effect

Taking stress off of the doctors and medical staff to allow them to see more patients

Politics is related the population’s welfare state expansion which in turn affects society’s degree to care for its citizens and the labor market policies. These policies in turn affect the health sector by affecting the population’s social and income inequalities. The previous Obama government brought about tremendous changes in health care through policy changes including changes on the number of insured patients and payment rates in hospitals among others. With the new Trump administration however, the various healthcare organizations are uncertain of how their businesses are going to look like since the new government is likely to result in reversal of various policies set by the previous government.

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.