Internal medicine associates : decision analysis in an evolving healthcare environment / Michele M. McGowan.

Format:

Book

Author/Creator:

McGowan, Michele M., author.

Series:

SAGE Business cases.

SAGE Business cases

Language:

English

Subjects (All):

Medicare beneficiaries--Case studies.

Medicare beneficiaries.

Health care reform--Case studies.

Health care reform.

Physical Description:

1 online resource.

Place of Publication:

London : Institute of Management Accountants, 2020.

Summary:

Physicians are reimbursed for the care they provide on a fee-for-service basis, a payment model where healthcare providers are paid separately for each service (e.g., office visit, test, or procedure). This payment model, however, incentivizes physicians to provide more treatment because payment depends on the quantity of care, rather than whether this additional care adds value or improves the patient's health outcomes (i.e., volume vs. value). This results in rising healthcare costs as physicians spend less time with patients focusing on preventative care. While commercial insurance companies continue to follow the fee-for-service reimbursement model, a variety of government reforms to Medicare Part B reimbursements over the years have been attempted, recommended, or initiated to rectify these inherent flaws.1The most recent legislation, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), consolidates three prior legislations replacing them with a single Merit-based Incentive Payment System (MIPS). MIPS is designed to reward physicians who provide high-value, high-quality care to Medicare beneficiaries with payment increases, and penalize physicians who are not meeting performance standards with payment decreases. The legislation is intended to be budget neutral, meaning total payments made for positive payment adjustments must be offset by total payments made for negative payment adjustments. Payment adjustments are made on a sliding scale based on a weighted-average score drawn from performance in four MIPS categories (quality, cost, improvement activities, and promoting interoperability).Once calculated, the provider's composite MIPS performance score is compared to composite MIPS performance scores for all participating providers to determine the respective provider's payment adjustment, which ranges from −9% to +9%. For physicians to succeed in the MIPS environment, there must be a commitment to continuous performance improvement. Increased competition among clinicians to achieve high MIPS scores will increase benchmark measures, raise score thresholds, and escalate the financial and reputational stakes.

Notes:

Originally Published InMcGowan, M. M. (2020). Internal Medicine Associates: Decision Analysis in an Evolving Healthcare Environment. IMA Education Case Journal, 13(3), Article 1.

Description based on XML content.

ISBN:

1-5297-9725-X

9781529797251

OCLC:

1289625356