ANSWER:
Policy/Regulation Fact Sheet
Nursing Informatics
The Medicare Access and CHIP Reauthorization Act (MACRA)
The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act was passed by the Congress and signed into law in 2015. The legislation supported healthcare transformation from the quantity of care and cost of care currently practiced to a new system of value-based system. The system is geared towards pay for the quality and value of care provided instead of considering the volume of care. MACRA focused on several provisions; the payment tracks and the sustainable growth rate (SGR) methodology for determining the fee schedule for Medicare coverage (Sayeed et al., 2017). There were two main payment tracks covered by the legislation; alternative payment models and merit-based incentive payment system (MIPS). The alternative models ensured a well-developed program for the clinicians’ incentive payment besides their regular fee for service (Soylu et al., 2020). MIPS system covered the coverage of Medicare quality programs that existed within the healthcare organization.
The aim behind developing the MACRA act was to ensure fair payment of physicians and care providers and improve the cost of care provided. There was ensured physician reimbursement and a healthcare model that was centered on the quality of care, value, efficiency, and effectiveness of medical care provided through its passing.
Impact on System Implementation
MACRA led to the implementation of a new physician payment system using Medicare coverage. The system ensures consolidation of the performance reports and various incentive programs. Additionally, the act has led to the development of other incentive programs for physicians using different payment models. As a result, there has been a significant improvement in the health information system as the physicians have payment options to choose from. MACRA resulted in developing a scale of reimbursement known as the resource-based value scale (Hussey et al., 2017). Payment and accountability have been improved through the new act, and as a result, the quality of care improved. It is easier to monitor the care provided by physicians. It has created a culture of accountability among all care providers, not only physicians. A new system was developed that ensured the physicians could also be penalized for their performance. Through performance-based payment methods, the integration of electronic health records in healthcare has been enhanced.
A well-developed health information system (HIS) ensures effective follow up on the quality of care. Physicians are easily monitored via the HIS and the value of care gauged on the cost. It is challenging for any facility to ensure good follow up without integrating a sound information system. MACRA promotes HIS’s effective use in healthcare as it cannot be practical in organizations without the electronic health records to provide relevant information for care provided.
Impact on Clinical Care
Due to physician accountability, there has been significant improvement in the quality of care provided. MACRA helped improve healthcare by providing a clear picture of Medicare reimbursement for physicians in the United States (Squitieri & Chung, 2017). Initially, it was challenging to determine the pay for physicians due to insufficient follow-up services. Additionally, the Affordable Care Act (ACA) was also introduced in 2015 to solidify the targets that were set by the secretary of health and human services (HHS), Sylvia Matthews Burwell (Lin et al., 2017). Through her efforts, care was shifted from fee for service (FFS) to value-based payment. Since the introduction of the healthcare act, all Medicare-covered facilities’ types of services have improved over the years. The cost of care has also decreased over the years as Medicare ensures that physicians get paid only for the quality of services provided and not the number of services. Hence, MACRA has led to the overall improvement of the patient outcomes in the US populations.
Organizational Policies
MACRA has resulted in an emphasis on responsibility and accountability. The hospital where I practice made it a policy for all physicians and nurses to enter any prescription and management done to a patient electronically. Additionally, no patient is supposed to become admitted without Medicare coverage.
References
Hussey, P. S., Liu, J. L., & White, C. (2017). The Medicare Access and CHIP reauthorization act: Effects on Medicare payment policy and spending. Health Affairs, 36(4), 697-705.
Lin, E., MaCurdy, T., & Bhattacharya, J. (2017). The Medicare access and CHIP reauthorization act: Implications for nephrology. Journal of the American Society of Nephrology, 28(9), 2590-2596.
Sayeed, Z., El-Othmani, M., Shaffer, W. O., & Saleh, K. J. (2017). The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: what’s new?. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 25(6), e121-e130.
Soylu, T. G., Goldberg, D. G., Cuellar, A. E., & Kuzel, A. J. (2020). Medicare access and CHIP Reauthorization Act in small to medium-sized primary care practices. The Journal of the American Board of Family Medicine, 33(6), 942-952.
Squitieri, L., & Chung, K. C. (2017). Value-based payment reform and the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: A primer for plastic surgeons. Plastic and reconstructive surgery, 140(1), 205.
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QUESTIONS:
Policy/Regulation Fact Sheet
As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.
With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.
In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.
To Prepare:
Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics.
Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA).
Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study.
The Assignment: (1 page not including the title and reference page)
Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:
Briefly and generally explain the policy or regulation you selected.
Address the impact of the policy or regulation you selected on system implementation.
Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.
Use APA format and include a title page, in-text citations, and reference page.
