Medicare Ineffective Payment

ACA Medicare Incentive Payments
INTRODUCTION:
United States expenditure on the healthcare system is much more than any other developed country in the world. Despite spending trillions of dollars there are more than 29 million Americans who lack the health insurance. US healthcare system works as a market place where multiple stakeholders including government agencies, public and private insurers and other investors work in liaison to provide healthcare to US citizens. This creates an essence of a business model where healthcare is considered in terms of profits and loss as oppose to service for the destitute. The US healthcare spending has been on the rise since the past many decades attributed to the changing landscape in medical technology
The traditional fee-for-service and the usual, customary and reasonable methods by the hospitals and physicians to the diagnostic related groups and resource based relative value scale. The establishment of accountable care organizations and advanced primary care practice and payment methods like bundle and global payments are briefly explained. The Patient Protection and Affordable Care Act (ACA) which was passed in 2010 has also provided with multiple provisions in the development of new methodologies. ACA resulted in the formation of Center for Medicare and Medicaid Innovation (CMMI) under the Center for Medicare and Medicaid Services (CMS) to put forth some innovative models with an idea of tying the Medicare payments with a value based model. The aim is to formulate some potential prospects of reducing the healthcare cost while increasing the efficiency of the system and improving the overall care of the Medicare beneficiaries. The review also provides some alternative methods to the current Medicare system in comparison to other countries around the
It proposed to resolve many issues being faced by the healthcare delivery and the way the complex payment methodology is involved. The ACA target various aspects of the health reforms addressing the healthcare delivery, its organization and the reimbursement methodologies. It provides multi-variable approach to build various new models to identify more efficient and productive system. The reimbursement system is linked to the patient’s outcome, the healthcare delivery and more importantly developing nation-wide resources for providing quality healthcare. Similarly, Medicare under ACA has substituted its predominantly fee-for-service structure to value based model of care providing an enticement to reduce the overall cost and expenditure for its beneficiaries.