Enactment of the Medicare Access and CHIP Reauthorization Act (Essay Sample)

MACRA (Medicare Access and CHIP Reauthorization Act)
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Abstract
When Congress repealed the Medicare physicist payment sustainable growth rate system in 2015, it did away with the requirement that payments be reduced when expenditure exceeded projections. Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which established a two-way payment structure that incentivizes physicians to accept alternative payment methods. Although the precise nature of MACRA's effect on healthcare services is unknown, it may have a significant impact. The health care payment and a delivery simulation model developed by the RAND Corporation was used to assess the impact of MACRA on Medicare spending and use and how the implications may change depending on the scenario under consideration. The projection was that Medicare spending on medical services in 2015-30 would be lowered by $35 billion to $106 billion, and hospital costs would be decreased by $32 billion to $250 billion. The effects of alternative spending are heavily dependent on the strength of incentives, particularly incentives to reduce medical expenses and doctor responses to MACRA payment rates.
MACRA (Medicare Access and CHIP Reauthorization Act)
Introduction
Before the MACRA, the government tried to manage the increasing cost of treatment by setting a tight limit, called the Sustained Growth Rate, on Medicare paid for doctors (SGR). As a blunt tool, the SGR did not override patients and did not enhance healthcare quality. It has thus been the permanent focus of the doctors and patient organizations. In the years before the MACRA, parliamentary leaders have frequently decided to postpone the reduction of the SGR in response to this criticism (Joseph-Johnson, 2018). Finally, Congress passed the MACRA, which replaced the late SGR with a system to reward health care workers. This is accomplished by requiring suppliers to participate in either the merit-based incentive payment system (MIPS) or sophisticated alternative payment models (advanced APMs). Both approaches use a two-pronged approach to determining value in health care: quality and cost. Rather than compensating providers for given services, the CMS would financially encourage providers that provide high-quality, low-cost healthcare (Joseph-Johnson, 2018). The MACRA effectively transfers financial risks from taxpayers and patients to providers via provider accountability.
Goals and objectives of MACRA
MACRA's ultimate goal is to improve patients' overall health and reward effective practice while conserving or decreasing expenses. "Care quality will not get compromised," Akhter said. "For the time being, providers are looking for the best outcomes for the patient. So, the question is, 'How much does it cost to get this optimal outcome for the patient?' Essentially, if a patient needs three things to get the best results, do not add a fourth (Joseph-Johnson, 2018). That is what we mean when we say "sufficient expenditures." The utilization of technology that gives real-time information on a patient's development, such as when they have plateaued or when there are early indications that they are deteriorating, is required to respond proactively to deliver the greatest outcomes while maximizing income."
MACRA Sponsors
MACRA is a policy enacted by the government; the government stands to be the sponsor of this policy to achieve its goal.
Population to be served by MACRA Act Policy
Under the MACRA, eligible clinicians are automatically assigned to the merit-based incentive-paid (MIPS) system. It is recommended that most clinicians who treat Medicare patients be included in the MIPS system.
The implication of MACRA in healthcare practices
The Medicare Access and CHIP Reauthorization Act (MACRA) lays down new ways of reimbursing medical professionals for healthcare recipients. This is done via two paths, MIPS and APMs. MIPS comprises four components, i.e., quality, advance care information, improved activity, and a cost-friendly final result. APMs are closer to traditional medicines in that providers are encouraged to treat a higher volume of patients by APM and may be more or less reimbursed based on patient outcomes in health systems (Spilberg et al., 2018). Data gets collected and submitted, and refunds are made at a later date based on such data. With certified EHR technology for MIPS and APM, the EHR is central to the quality payment program to qualify for positive Medicare payment changes. Although meaningful use as an independent program vanishes, the MIPS requirements and the technology to achieve them remain important. In the coming years, EHR technology must comply with its 2015 Health IT certification edition following the proposed MACRA Rule, which is strongly focused on using APIs to secure secondary and tertiary use of clinical health data. Additionally, CEHRT and APIs also allow for an ecosystem in which providers are successful in managing population health and developing analytical approaches to the provision of care (Spilberg et al., 2018). Simultaneously, these APIs should allow patient data to contribute more directly to the overall picture of a patient's health profile.
Ethical principles involved in MACRA legislation
Value is the key driver of MACRA and MIPS organizational principles. These core principles, known as the principality in health ethics, include beneficence, nonmaleficence, autonomy, and justice. By using these four principles to prioritize stakeholders as much as possible, board members and leaders can avoid or at least mitigate the negative consequences of some of the ethical challenges posed by MACRA and MIPS (Baumane-Vitolina & Sumilo, 2016). , Beneficence is one of the principles. Beneficence is more than harm avoidance. It does indeed suggest a degree of altruism. It appears reasonable to conclude that emphasizing the quality of care rather than the amount of care extends the benefit principle further. However, the measures remain largely concentrated in the diseased part of the disease-wellness continuum. A metric linked to the quality of life, for example, does not form part of the measurement system. Should only the criteria linked to financial incentives and incentives be focused on the goal of healthcare? How should the financial incentives for service be balanced against the value-based financial incentives?
The other one is nonmaleficence. The emphasis on quality and increased use of electronic health records appears to embrace the nonmalic principle by establishing processes that emphasize patient safety (Baumane-Vitolina & Sumilo, 2016). It has been demonstrated that providers of well-organized, timely data systems reduce medical errors. Should financial incentives or disincentives be aimed at individual doctors and providers who can choose their bonus compensation based on quality and cost criteria rather than the best medical interests of each patient? Additionally, autonomy is the other principle. It can be assumed that MACRA and MIPS are not familiar to the average patient (Baumane-Vitolina & Sumilo, 2016). In addition, the average patient does not know how to assess and classify provider performance or how incentives are paid. Given this unacceptable reality, the patient will lose his autonomy regarding his role and the care provider's role. Provider autonomy may be at risk. Aside from that, all incentives are aimed at achieving desired outcomes. As a result, other metrics may be compromised (Baumane-Vitolina & Sumilo, 2016). What about other motivational forces like patient-centeredness, improved population health status, and reduced per person care costs?