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    Medicare Revolution: Profiting from Quality, Not Quantity
    Medicare Revolution: Profiting from Quality, Not Quantity
    Medicare Revolution: Profiting from Quality, Not Quantity
    Ebook39 pages23 minutes

    Medicare Revolution: Profiting from Quality, Not Quantity

    By Adriel Bettelheim

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    About this ebook

    One of the most controversial aspects of the Affordable Care Act, also known as Obamacare, was how the government measures the cost effectiveness and quality of care and factors it into the way doctors, hospitals and other providers are paid.

    The decisions determine how Medicare and other big public health programs spend hundreds of billions of dollars each year and strongly influence the coverage decisions of private insurers.

    This brief CQ Roll Call guide examines the twists and turns of the long “doc fix” journey and what happened in one of the biggest legislative achievements of 2015, which will wean health programs away from the existing fee-for-service system, and other attempts to deal with doctor pay.

    Author Adriel Bettelheim, the managing editor of the CQ health team, along with CQ HealthBeat associate editor Kerry Young and heath care policy writer Melissa Attias, guide you through the new criteria and payment models, from penalizing doctors who don’t report quality measures to giving hospitals and health plans bonus payments for improved year-to-year performance.
    The book also looks ahead to the impact of the change, exploring how the health care industry is reconfiguring itself and developing new delivery systems to adapt to this trend of value-based purchasing.

    If you have an interest in health care payments, you need to read this ebook.

    LanguageEnglish
    PublisherCQ Roll Call
    Release dateApr 28, 2015
    ISBN9780996311021
    Medicare Revolution: Profiting from Quality, Not Quantity
    Author

    Adriel Bettelheim

    Adriel Bettelheim oversees coverage of health policy for CQ Roll Call and has held senior editor and reporter positions with the company for more than 12 years. He also has covered business and government for Bloomberg News, PolitiFact and the Denver Post and was part of the PolitiFact team awarded the 2009 Pulitzer Prize for National Reporting. He is the author of "Aging in America: A to Z" and has appeared as a commentator on CNN, Fox News, MSNBC, C-Span, BBC, NPR and local television and radio outlets.

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      Book preview

      Medicare Revolution - Adriel Bettelheim

      Copyright © 2015 by CQ Roll Call.

      All rights reserved, including the right to reproduce this book or

      portions thereof in any form whatsoever.

      CQ Roll Call spring 2015 edition

      Chief Content Officer: David Ellis

      Editors: Melissa Attias, Georganne Coco and Kerry Young

      Design Director: Marilyn Gates-Davis

      Principal photographers: Tom Williams and Bill Clark

      CQ Roll Call, 77 K St. N.E., Washington, D.C. 20002-4681

      cq.com, rollcall.com

      ISBN: 978-0-9963110-2-1

      Chapter 1

      Under the Microscope

      Chapter 2

      The Doc Fix

      Chapter 3

      Coverage Changes Ahead

      Chapter 4

      More Initiatives Ahead

      Chapter 5

      More Accountable Care Organizations

      Key Players

      About the Authors

      About CQ Roll Call

      Chapter 1

      Under the Microscope

      It seemed so far-fetched.

      Pitch partisanship, distrust and five years of gridlock had built up around the implementation of the 2010 health care law and stymied action on other medical policy issues.

      But then, a polarized Congress delivered the unexpected. And, on April 16, President Barack Obama enacted a new law addressing a far-reaching issue with the potential to change the way health care is delivered to Americans: how government health programs pay doctors, hospitals and other providers.

      This was a bipartisan effort, Republicans and Democrats coming together to do something that’s smart and common sense, Obama said. My hope is it becomes a habit.

      In this case, urgency trumped political considerations.

      Entitlement programs such as Medicare and Medicaid spend upward of $1 trillion each year reimbursing health care professionals for services they deliver to beneficiaries.

      Often, the payouts are tied to the volume of tests, procedures and office visits delivered – a situation critics say has stoked a dangerous spending spiral without assuring the best outcomes for patients.

      Indeed, the United States has the most expensive health care system in the world but ranks at or near the bottom among developed nations on issues of efficiency, access and

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