Issue Identification Presentation Robert Powell MSN, APRN, FNP-BC - - PowerPoint PPT Presentation

Issue Identification Presentation

Robert Powell MSN, APRN, FNP-BC NURS 638 Health Policy Leadership & Advocacy Virginia Commonwealth University

Learning Objectives

• Review purpose of MACRA’s Quality Performance

Program (MIPS)

• Identify how shared medical appointments (SMAs)

support MACRA

• Examine SMAs impact on the Triple Aim and ultimate

quality/safety

Health Policy Issue Introduction

• MACRA’s history

– Signed into law April 16, 20151 – Passed by > 90% Congressional support1 – Replaced 1999’s Sustainable Growth Rate system1 – Supports a shift from volume to value1

• Two payment models within MACRA1

– The Merit Incentive Payment System (MIPS) – Alternative Payment Models (APMs)

Health Policy Issue’s Relevance to Quality & Safety

• 4 categories of performance under MIPS2

– Quality (formerly PQRS) – Cost (formerly Value Based Modifier) – Advancing Care Information (formerly MU) – Improvement Activities (IA)

• Group visits (i.e., SMAs) identified as a 2017 IA_BE_19
• SMAs linked to Triple Aim by offering high-quality, high-value,

low cost care coupled with timely access3,4,5

Implication of Policy Action

Fee-for- Value

Better care Smarter spending Healthier people

Implication of Policy Action/Inaction

• Quality & value > quantity requires restructuring
• FFS linked to HC cost and fragmentation6
• 1997-Congress capped SGR provider payments

however HC costs continued to rise6

• HC cost passed $3 trillion in 2014 w/ ~20% tied to

physician payments6

• 2015-CMS announced payment links to quality

services

Theoretical Frame of Reference

van Amstel, F. (Designer). (n.d.). Garbage can model. Retrieved from http://fredvanamstel.com/publications/a-problem-solving-game-for-collective-creativity

Integrating Health Policy Issue & Theory

• Problems: FFS is not Fee-

for-Value; suboptimal HC efficiency/effectiveness

• Solutions: Alternatives to

SGR formula

• Opportunities: MACRA;

administration changes

• Participants: Researchers,

academics, President, Congress, providers

The Garbage Can Decision Process. (n.d.). Retrieved from http://www.newfoundations.com/OrgTheory/SchoolasOrg_files/image019.gif

Learning Objectives

• Review purpose of MACRA’s Quality Performance

Program (MIPS)

• Identify how shared medical appointments (SMAs)

support MACRA

• Examine SMAs impact on the Triple Aim and ultimate

quality/safety

References

1. Coker Group. (2017). A systematic approach to performance improvement under MACRA’s quality performance program: White paper. Retrieved from http://cokergroup.com/wp-content/uploads/2015/07/A-Systematic-Approach-to- Performance-Improvement-Under-MACRAs-Quality-Performance-Program_May-2017.pdf 2. McLaughlin, D. B. (2017). MACRA: An overview and implications. Healthcare Executive, 32(3), 56-59. Retrieved from http://proxy.library.vcu.edu/login?url=https://search-proquest- com.proxy.library.vcu.edu/docview/1900779243?accountid=14780 3. Rubenstein, J. (2014). Shared medical appointments in urology. Reviews in Urology, 16(3), 136–138. 4. Wong, A. L., Martin, J., Wong, M. J., Bezuhly, M., & Tang, D. (2016). Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial. Plastic Surgery, 24(2), 107-111. Retrieved from http://proxy.library.vcu.edu/login?url=http://search.ebscohost.com.proxy.library.vcu.edu/login.aspx?dire ct=true&AuthType=ip,url,cookie,uid&db=a9h&AN=116897317&site=ehost-live&scope=site 5. Giladi, A. M., Brown, D. L., & Alderman, A. K. (2014). Shared medical appointments for preoperative evaluation of symptomatic macromastia. Plastic and Reconstructive Surgery, 134(6), 1108-1115. doi:10.1097/PRS.0000000000000750 6. Jones, L. K., Raphaelson, M., Becker, A., Kaloides, A., & Scharf, E. (2016). MACRA and the future of value-based

• care. Neurology: Clinical Practice, 6(5), 459-465.

7. van Amstel, F. (Designer). (n.d.). Garbage can model. Retrieved from http://fredvanamstel.com/publications/a- problem- solving-game-for-collective-creativity 8. Einsiedel Jr., A. A. (1983). Decision-making and problem solving skills: the rational versus the garbage can model of decision-making. Project Management Quarterly, 14(4), 52–57.

Questions