|Type of paper:||Research paper|
|Categories:||Medicine Healthcare policy Public health|
The new healthcare reform bill provides for the issuance of incentives to healthcare providers, designed to encourage and motivate them to deliver quality services for improved healthcare outcomes. Primarily, the incentives offered by the Affordable Care Act (ACA) are applied to influence the behaviors of healthcare providers, including the quantity and quality of care provision (Doran, Maurer & Ryan, 2017). Nevertheless, the implementation of the reform bill on incentives has faced several risks and which have limited the value of healthcare, thus not being able to provide better outcomes. This paper discusses the incentives offered in the Affordable Care Act and the risks experienced in implementing these incentives in healthcare provision.
Through the Medicare Shared Savings Program (MSSP), ACA brought together with care organizations that accept combined responsibility for cost and quality of Medicare patients they treat. Through ACA provisions, the care organizations agree to divide the savings they make as incentives. Not only do these organizations share savings but also risk and resources to increase healthcare coordination (Vu et al., 2016).
The ACA has several provisions that are aimed at building the foundation to bring in reforms in Medicare payment schemes. The provisions aim at endorsing the growth and coverage of advanced payment approaches to expedite the implementation of efficient healthcare provision models. The ACA provision also focuses on relating payments to patient experiences and care outcomes and hence giving incentives to healthcare providers for reducing the estimated spending for the patients (Abrams et al., 2015). One of the earliest provisions of ACA relates to reimbursing healthcare providers to slow down the increasing rates in fee-for-service payments. The ACA furthermore provides incentive rewards to Medicare Advantage plans for getting high ratings, which is based on performance in delivering quality healthcare and experiences to their patients. An example is a case where the ACA has lowered yearly upsurges in Medicare fee rates for hospitals. ACA has also set expectations for healthcare providers to be more efficient in administering care to patients over time. The ACA provisions also advocate for a reduction in overpayments in private plans providing Medicare benefits through the Medicare Advantage plan and linking them to performance ratings (Abrams et al., 2015). Incorporation of plan-performance rewarding to the prevailing efficiency incentives is projected to back-up the notion from quantity to value in healthcare provision
The Affordable Care Act (ACA) also makes provisions targeting quality healthcare concerns which result to inefficiencies and jeopardizing the health of patients. The Act has laws imposing financial fines on healthcare facilities with high readmissions rates and hospital-acquired illnesses. Such financial sanctions have been effective in reducing cases relating to medical events. On the other end, the value-based purchasing plan for healthcare facilities has fostered a high level of performance accountability (Chait & Glied, 2018). The law dispenses penalties and bonuses linked to identified quality measures. Physicians are also subjected to the law where they are required to be accountable for their healthcare provision services. In situations where poor quality services are delivered to patients, physicians are subject to being penalized.
The new healthcare reform bill has also had provisions for bonuses to hospitals that attain high-level standards on patient experience and healthcare outcomes. According to Anderson et al., "As of 2015, 1.5 percent of base payments for more than 3,500 hospitals is withheld and used to reward top-performing hospitals for the quality of their care and their patients' experiences of care; this amount increases to 2.0 percent by 2017". The Act also provided parallel programs for healthcare providers in all hospitals to ensure that the best patient care is provided. With the provision of bonuses rewards, both hospitals and physicians are motivated to up their game not only for individual benefit but also for the best of their patients.
The Medicare Access and CHIP Reauthorization Act (MACRA) regulation under ACA focuses on introducing a Merit-based Incentive Payment System (MIPS) (Anderson eta. 2015). MIPS program is meant to combine the value-based initiatives which link payments closer to performance measures. In regards to this, the new reform bill aims at building metrics that provide measurements of performance accuracy. The enactment of the Merit-based Incentive Payment System (MIPS) will see payments physicians and hospitals being incentivized based on how they healthcare merit.
Though the incentives on medical providers have been hyped to improve patients' outcomes and healthcare value, the evidence available appears to differ. The main challenge to value-based healthcare and incentives relates to some technical concerns. These concerns make it hard to accurately define and measure the fundamental aspects of quality healthcare and their impacts on patient results (Doran et al. 2017).The incentive scheme operates on a basis of one-size-fits-all. Therefore, the incentive scheme promotes a guideline-driven methodology which discourages healthcare providers from preferring individual patients. The incentive approach in the healthcare provision is also likely to degrade some of the indispensable virtues including compassion, altruism, and trust (Doran et al. 2017)
In conclusion, the Affordable Care Act has improved healthcare provision and accessibility in both the private and public healthcare institutions. The Act has brought about a considerable bargain that fee-for-service should not define healthcare provision. The Act calls for substantial changes that are necessary to ensure high quality, affordable, and value-based care (Vu et al., 2016).
Anderson, G. F., Davis, K., & Guterman, S. (2015). Medicare payment reform: aligning incentives for better care. Issue brief (Commonwealth Fund), 20, 1-12.
Abrams, M., Nuzum, R., Zezza, M., Ryan, J., Kiszla, J., & Guterman, S. (2015). The Affordable Care Act's payment and delivery system reforms: a progress report at five years. Issue brief (Commonwealth Fund), 12, 1-16.
Doran, T., Maurer, K. A., & Ryan, A. M. (2017). Impact of provider incentives on the quality and value of health care. Annual review of public health, 38, 449-465.
Chait, N., & Glied, S. (2018). Promoting prevention under the affordable care act. Annual review of public health, 39, 507-524.
Vu, M., White, A., Kelley, V. P., Hopper, J. K., & Liu, C. (2016). Hospital and health plan partnerships: the Affordable Care Act's impact on promoting health and wellness. American health & drug benefits, 9(5), 269.
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