MACRA: The impact on hospitals Michael O’Loughlin, Thomas Farquhar and Ethan Foxman

Joint Conference on 6^th International Conference on Clinical & Medical Case Reports & 11^th Global Healthcare & Fitness Summit

October 16-18, 2017 San Francisco, USA

Sameer Rehman

Hartford Hospital, USA

Scientific Tracks Abstracts: J Clin Case Rep

Abstract :

Traditionally Medicare Reimbursement has been based on fee for service and volume (Sustainable Growth Rate). however, Medicare Access Chip Reauthorization Act 2015 (MACRA) eliminates the fee for service reimbursement and replaces it with a system that links reimbursement to value and quality of care. This is called Quality Payment Program. The purpose of this exhibit is to understand quality payment programs, specifically Merit based Incentive Payment System (MIPS) and Alternative Payment Methods (APMS) and to review MACRA, why and how it is being instituted and detail the impact on Hospitals? MACRA is a bipartisan federal legislation signed in to law on April 16, 2015. In the simplest possible terms, MACRA repeal the Sustainable Growth Rate formula that has determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care. Under MACRA, the participating providers will be paid based on the quality and effectiveness of the care they provide. A growing percentage of physician payment will be based on value- not on volume- like the current fee for service system. High value care will be defined by measures of quality and efficiency and providers will earn depending on their performance against those measures. Providers will receive a MIPS composite score of 0-100, calculated from the four categories already listed and weighted as follows: Quality- 50% in 2019, 30% thereafter, Advancing Care Information- 25% in 2019 and thereafter, resource Use- 10% in 2019, 30% thereafter, an annual performance threshold based on median or mean composite scores of all physicians in a prior period will determine reimbursement rates, providers falling within the mean will see a flat adjustment rate, those below the mean will see a drop in rate and those above will see an increase in rate.

Biography :

Sameer Rehman is a 4th year Postgraduate Radiology Resident Physician at Hartford Hospital in Connecticut. He has completed two years of surgical training and healthcare focused MBA prior to starting Radiology Residency. He has published several research papers and written book chapters in disciplines of Surgery, Radiology and Healthcare Economics. He aims to improve healthcare delivery by developing an efficient healthcare model via research and innovation. His clinical interest lies in Interventional Radiology/Oncology.