Struggling to make ends meet is never easy, and can be made all the more challenging when adding in the cost of healthcare, especially if a person has several health conditions with which he or she is trying to cope.  Many patients that are on Medicare can sometime feel conflicted about how to handle their money, and have been pushed even further into stressful situations with the fact that many doctors and facilities were turning away patients that utilized Medicare.  Finding providers with Medicare access had been difficult, but in recent years, this has been alleviated with the implementation of MACRA or Medicare Access and CHIP Reauthorization Act.


Defining MACRA

It seems like every time you turn around there is a new acronym to understand, and this seems to be doubly true for the healthcare community.  MACRA is a program with Medicare and Medicaid programs in mind, but almost all the other health insurance providers are keeping a close eye on the results so that they might employ some of the same standards.  This changes the old mentality of a fee-for-service billing package, and puts more responsibility and accountability for quality of service on the healthcare professional’s shoulders.  Thus, if a patient is readmitted to a hospital, that hospital is now under more scrutiny and could face lower reimbursement percentages when billing Medicare. 


Quality and improvement of services is truly the main focus of MACRA due to the ever-present trend upwards of healthcare costs.  Obviously, there are reasonable causes for some increases to the cost of healthcare, but Medicare, as well as many other healthcare insurance carriers noticed that care was not improving at the same rate that costs were going up.  To motivate hospitals and clinics to change their old ways of handling care, the structure of care payments is now tied directly to patient care, outcomes, and satisfaction levels. 


Why the big change?

One of the biggest purposes behind such a big overhaul to the healthcare industry goes to the implementation of digital health records and the need for technological aid for physicians.  For those of you that have seen the evolution of healthcare practices probably recognize the easy in which information is transmitted to different doctor’s offices or is accessed when necessary.  This hasn’t been a simple process of change, but one that has been a long time in coming, and has allowed doctors to provide much more accurate care in a more timely manner. 


A second purpose for change has been to get the wasteful spending under control, as well as curb the cost of care by being fully aware of where money was being spent, where it might be saved, and making sure that when tests and procedures where being ordered, that they were justified and not just frivolous spending to make more for the healthcare organization.  When an organization had to validate and stand behind their decisions, more careful analysis was being made by those involved, and patients were also being asked to become more a part of their own health decisions.


Will this make a difference?

As with many aspects in life, immediate results are almost impossible to see, however, the Centers for Medicare and Medicaid Services (CMS) are taking the next couple of years to compile extensive and in depth data from all healthcare providers to understand what is good, bad and what needs to be tweaked a little more.  From now through 2019, clinics, hospitals and clinics are recording and reporting an wide range of data, which will help to show were quality, costs, information and activities are being directed.


In advance of any mandates or changes to how healthcare is conducted, many healthcare organization have invested in and are now using software that will help them to be more efficient, find where wasteful spending of time and resources are already occurring, and find ways to improve how healthcare is provided to each patient and to the community in which they serve.  In this way alone healthcare is already moving forward by leaps and bounds.


For all of those patients that have fought through hard times to find provides that have Medicare access, the change you have been waiting for has finally begun to happen, and it is a good time to be alive.  Healthcare is going through a bit of an evolution, with all of the growing pains associated with it, but they are also realizing some of the best results and most efficient care that has ever been achieved in history.  There are still some bumps in the road as more information is gathered over the next couple of years, however, this is not hindering organizations from stepping up and providing better care, and doing so ahead of any sort of regulatory changes.



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