HC 3308 EXAM 1- CH 1. QUESTIONS AND ANSWERS
100% SOLVED
MACRA (Medicare Access and CHIP Reauthorization Act) - ANSWER Extends funding
for Medicaid's Children's Health Insurance Program (CHIP) for 2 years and establishes a
physician payment schedule that predictably specifies the inflation rate for Medicare
physician reimbursement.
The MACRA also promotes paying for value and quality of care rather than quantity
through programs streamlining physicians' participation in quality reporting and
payment incentives using the merit-based incentive payment system (MIPS) and the
alternative payment models (APMS).
Physicians can choose one of two payment tracks:
1. Merit-Based Incentive Payment System
2. Advanced Alternative Payment Model Participation - ANSWER MIPS criteria include:
advancing care information (25%), clinical practice improvement (15%), resource use
(10%), quality (50%)
APM: You receive 25% of your Medicare Part B payments through an Advanced APM or
see 20% of your Medicare patients through an Advanced APM.
Implications of MACRA for clinicians - ANSWER Brings all clinicians into payment reform
reality
Measurement and reporting critical to success
Need for scale and infrastructure- physicians consolidation and employment
Emphasis on quality, outcomes, and primary care promotes population health
Greater incentives to primary care
Access to large data sets critical to success.
Tax Cuts and Jobs Act of 2017 - ANSWER Does repeal the individual shared
responsibility penalty - both as a dollar amount a a percent of income, effective 2019.
,Does NOT repeal section 5000A or the requirement for individuals to have health
insurance: an applicable individual shall for each month beginning after 2013, ensure
that the individual and any dependent of the individual, is covered under minimum
essential coverage for each month.
How big is the healthcare industry? - ANSWER Consumes more than 17% of nations
gross domestic product, exceeding 3 trillion in costs and employing a workforce of more
than 12 million.
World's 5th largest economy
What's more intimidating than it's size? - ANSWER the complexity of the system Solution:
if we had 1 payer only. More you expose yourself to hospitals/doctors, the more you get
trapped.
How is U.S's healthcare industry vs other countries? - ANSWER U.S. spends double the
GDP
Compared to 12 other high income nations, we have the lowest life expectancy and high
infant mortality rates
Ranked #11. We are poorer in quality and high in cost.
What problems do the ACA address? - ANSWER Quality, access, cost.
We increased access but the cost was out of balance.
We want best quality for low cost & available to everyone in the country.
Wanted to cover 32 million but only got 25 million.
What has the ACA done for health care? - ANSWER Reduce the rate of increase in
Medicare & Medicaid spending.
Decreases in DSH payments (takes care of high share medical business or rural
hospitals & get paid more because taking care of high charity cases)
Provides grants and loans to improve workforce.
, Includes provisions to reduce waste, fraud and abuse in Medicare & Medicaid
Impose new reporting requirements for tax exempt hospitals
Places significant restrictions on the expansion of physician-owned hospitals and
prohibits new facilities
Adopts delivery system reforms to better align reimbursements with improve
coordination of patient care & quality- take care of patient better so don't spend that
much on expenses & ACOs and bundle payment, pays just one person and they
distribute
What are ACOs? (Accountable Care Organization) - ANSWER ACOs are groups of
doctors, hospitals, and other health care providers, who come together voluntarily to
give coordinated high-quality care to their Medicare patients.
Who does the ACA cover? - ANSWER everyone except illegal immigrants
What is the basis to ACA opposition? - ANSWER Politics and cost
DSH (Disproportionate Share Hospital) - ANSWER Federal law requires these Medicaid
payments to states for hospitals serving large numbers of Medicaid and low income,
uninsured individuals.
The law establishes an annual DSH allotment for each state. DSH payments provide
critical financial supplements to hospitals serving neediest populations.
Why has health and disease data exploded over the last 50 years? - ANSWER the Govt
began analyzing information from medicare & medicaid claims, health & insurance
claims data, communicable & malignant diseases, international data
Birth rates have fallen and life expectancy has lengthened meaning - ANSWER older
people make up an increasing proportion of total populations.
prepathogenesis period - ANSWER individual is at risk for disease but not yet affected
100% SOLVED
MACRA (Medicare Access and CHIP Reauthorization Act) - ANSWER Extends funding
for Medicaid's Children's Health Insurance Program (CHIP) for 2 years and establishes a
physician payment schedule that predictably specifies the inflation rate for Medicare
physician reimbursement.
The MACRA also promotes paying for value and quality of care rather than quantity
through programs streamlining physicians' participation in quality reporting and
payment incentives using the merit-based incentive payment system (MIPS) and the
alternative payment models (APMS).
Physicians can choose one of two payment tracks:
1. Merit-Based Incentive Payment System
2. Advanced Alternative Payment Model Participation - ANSWER MIPS criteria include:
advancing care information (25%), clinical practice improvement (15%), resource use
(10%), quality (50%)
APM: You receive 25% of your Medicare Part B payments through an Advanced APM or
see 20% of your Medicare patients through an Advanced APM.
Implications of MACRA for clinicians - ANSWER Brings all clinicians into payment reform
reality
Measurement and reporting critical to success
Need for scale and infrastructure- physicians consolidation and employment
Emphasis on quality, outcomes, and primary care promotes population health
Greater incentives to primary care
Access to large data sets critical to success.
Tax Cuts and Jobs Act of 2017 - ANSWER Does repeal the individual shared
responsibility penalty - both as a dollar amount a a percent of income, effective 2019.
,Does NOT repeal section 5000A or the requirement for individuals to have health
insurance: an applicable individual shall for each month beginning after 2013, ensure
that the individual and any dependent of the individual, is covered under minimum
essential coverage for each month.
How big is the healthcare industry? - ANSWER Consumes more than 17% of nations
gross domestic product, exceeding 3 trillion in costs and employing a workforce of more
than 12 million.
World's 5th largest economy
What's more intimidating than it's size? - ANSWER the complexity of the system Solution:
if we had 1 payer only. More you expose yourself to hospitals/doctors, the more you get
trapped.
How is U.S's healthcare industry vs other countries? - ANSWER U.S. spends double the
GDP
Compared to 12 other high income nations, we have the lowest life expectancy and high
infant mortality rates
Ranked #11. We are poorer in quality and high in cost.
What problems do the ACA address? - ANSWER Quality, access, cost.
We increased access but the cost was out of balance.
We want best quality for low cost & available to everyone in the country.
Wanted to cover 32 million but only got 25 million.
What has the ACA done for health care? - ANSWER Reduce the rate of increase in
Medicare & Medicaid spending.
Decreases in DSH payments (takes care of high share medical business or rural
hospitals & get paid more because taking care of high charity cases)
Provides grants and loans to improve workforce.
, Includes provisions to reduce waste, fraud and abuse in Medicare & Medicaid
Impose new reporting requirements for tax exempt hospitals
Places significant restrictions on the expansion of physician-owned hospitals and
prohibits new facilities
Adopts delivery system reforms to better align reimbursements with improve
coordination of patient care & quality- take care of patient better so don't spend that
much on expenses & ACOs and bundle payment, pays just one person and they
distribute
What are ACOs? (Accountable Care Organization) - ANSWER ACOs are groups of
doctors, hospitals, and other health care providers, who come together voluntarily to
give coordinated high-quality care to their Medicare patients.
Who does the ACA cover? - ANSWER everyone except illegal immigrants
What is the basis to ACA opposition? - ANSWER Politics and cost
DSH (Disproportionate Share Hospital) - ANSWER Federal law requires these Medicaid
payments to states for hospitals serving large numbers of Medicaid and low income,
uninsured individuals.
The law establishes an annual DSH allotment for each state. DSH payments provide
critical financial supplements to hospitals serving neediest populations.
Why has health and disease data exploded over the last 50 years? - ANSWER the Govt
began analyzing information from medicare & medicaid claims, health & insurance
claims data, communicable & malignant diseases, international data
Birth rates have fallen and life expectancy has lengthened meaning - ANSWER older
people make up an increasing proportion of total populations.
prepathogenesis period - ANSWER individual is at risk for disease but not yet affected
