Sunday, 26 May 2019

MACRA Training: MACRA and Medicare Value-based Purchasing


Part of MACRA Training and Medicare includes a huge focus on value-based purchasing for healthcare organizations. Medicare Value-based Purchasing links financial incentives with the performance of an organization. The understanding for this linking started back in the late 90’s, with the help of the Health and Human Services (HHS) department when they sought initial knowledge why improvements were not being seen with patients, even though technology and grasp of medicines were on the increase. The first few organizations willing to participate in the study were watched and paid for their performance or outcomes with patients rather than the number of services they provided. The resulting information saw a small but noticeable difference in both the experiences with patients being more positive and a lower of the overall costs involved with each patient.

MACRA Training


The biggest jump towards implementation and required standards for Medicare Value-based Purchasing came with enactment of Obamacare (The Patient Protection and Affordable Care Act) when the bar went from casual operation to full Medicare involvement and standardization. But, going back to the analogy of the aircraft carrier, nothing as big as healthcare moves that nimbly or quickly. Along with the fact that not everything was known about the program as a whole has led to some revamping of requirements and some retuning of the benchmarks that must be reached. These changes are still happening and may continue to happen as this large program discovers more information to help Medicare understand finite details.


Healthcare organizations have been thrown into the deep end of the pool with this. A few things that have been plaguing them include:


Ambiguity when it comes to standards– statements from Medicare may say, “Improve patient care,” but this is a generalized request, not a standard that can be quantified, tracked and recorded. Defining their own standards– because the system is still somewhat new, things like baselines and standards are being asked to be defined by each organization by themselves

Large organizations vs. small– most larger organizations are able to cut costs better just because they have more resources to draw upon and thus can make more significant cuts, while the smaller organizations may be penalized more because they can’t make as many cuts to costs

MACRA Training

More than any one thing, data is the key to being able to meet any standard of improvement to patient quality of care along with cutting costs and waste out of daily practices. The data helps to show where problem areas exist, where resources may need to be reassigned, and where patients are not receiving the best care possible. In order to achieve this, healthcare facilities are having to be more creative with how they think about their business as a whole, how they perform that business and identify ways to improve the system, possibly from the ground up. This is no small feat for any business, let alone one that has such high demands as healthcare. One characteristic that should be a part of the overhauling process is the ability to be flexible to changes as they come up.


With the Medicare Value-based Purchasing system being still in its infancy, and with the aforementioned possibility of changes to systems and standards, healthcare organizations can’t sit on their collective hands and talk about the changes that need to be implemented. Instead, they must be able to move that ship on a dime, thus implementing new standards as quickly as possible.


“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people.” Douglas E. Henley, M.D. – executive vice president and chief executive officer of the American Academy of Family Physicians


None of this is true all that simplistic in its fundamentals, nor is it going to be easy moving forward. However, the end goals of better care and lower costs need to be met as soon as possible, and the Medicare Value-based Purchasing is the path that everyone has been put upon. It is an evolution from the old ways of thinking and handling healthcare, which can truly be a good thing for all of us because, at some point, we all become a patient in the system.