Health care cost versus quality is a contentious political topic these days, And historically, Medicare has received a lot of the attention when it comes to cost-benefit analysis. But some policy changes are not only transforming how this issue is accounted for — they’re creating a data-driven approach toward improving quality of care.
Last year, Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which seeks to incentivize health care quality from care facilities reimbursed through the Medicare program, in an effort to transition the health care industry from fee-for-service to value-based care. Doctors and facilities with higher quality ratings will receive more compensation for their patient visits, and, conversely, they will be penalized for negative care feedback. This is all tied to the act’s Quality Payment Program (QPP), which went into effect on Jan. 1 of this year.
There are multiple payment systems in place through the QPP to create this positive reinforcement. The first is Merit-based Incentive Payment System (MIPS), a single payment program that uses a composite score of based on quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record (EHR) technology to determine payment. This payment can change drastically based on performance, able to swing between -9 percent to +27 percent by 2022.
Otherwise, doctors can join an accountable care organization (ACO) — which were already incentivized to create higher levels of care at lower costs through the Affordable Care Act — to take advantage of Alternative Payment Models. These networks, which tend to attract remote and rural health organizations, will be exempt from MIPS and will get a 5 percent annual reimbursement from MACRA. Alternatively, ACOs may also opt for advance payments to go toward advancing their care infrastructure.
Prior to this step, there was little transparency and information available to directly tie patient outcomes and cost related to Medicare reimbursements, which were tied to quantity and not quality. But under MACRA, there is an opportunity for analytics firms, EHR companies and ACOs to use this data to try and distinguish themselves and show how their services are essential to quality patient care. Central to this will be data collection, and EHRs will continue their importance, this time as vital forecasting tools to serve as a basis of quality care. By coupling this information with other available data sets on patient outcomes, reduced need for procedures and decreases in medical errors, health care can get big data insights on what works and what doesn’t and at what price point.
However, leadership from thePhysician-Focused Payment Model Technical Advisory Committee recently testified before the House Energy and Commerce health subcommittee saying many proposals have limited strategies for sharing data.
Access to data could prove pivotal to assessing quality care versus cost. With 2017 quickly coming to a close, this first performance year will illuminate just how far the health care field has come from the days of paper records to today’s landscape of quantifiable, data-driven quality care outcomes.
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