Risk Management and Legislative Trends in Healthcare

This analysis highlights recent trends in U.S. healthcare legislation, particularly focusing on the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The paper explores how this legislation addresses long-standing issues such as inefficiency, underinsurance, and rising costs within the he...Read More

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Risk Management in Health Care
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Overview
Trends in the healthcare system are remarkably influenced by local, state, and federal
health care legislation. The present paper describes the general trends in healthcare legislation
over the past five years. Further, it describes a particular legislation, namely Medicare Access
and CHIP Reauthorization Act of 2015, how it governs a long trending healthcare concern,
and the motivating factors behind the legislation. The impact of the trending legislation on
health care overall in the United States are highlighted thereafter. The next section of the
paper describes how the selected legislation effects hospital care setting. The changes that
have occurred in a selected healthcare setting for meeting the needs of this legislative trend
have been identified. Lastly, the impact on stakeholders has been analysed.
Trends in health care legislation over the past 5 years
Healthcare legislation reforms have been an evolving one in the United States, and the
last one decade is of prime significance in history. Precisely, the past five years time frame
has witnessed remarkable trends in health care legislation. Legislations have been laid out,
and a number of them have been proposed in relation to reduction in medical care costs. As
indicated by evidence, the trends in healthcare legislation are directed towards insurance
availability and cost, quality of healthcare services and minimisation of fraud (Young &
Kroth, 2017).
Specific legislation and how it governs a long trending health care concern
The Medicare Access and CHIP Reauthorization Act of 2015 (MARCA) also termed
as the Permanent Doc Fix, is a statue passed in the United States aiming to change the
payment system for physicians treating Medicare patients. This piece of legislation revises
the Balanced Budget Act of 1997. The Act has been noted as the largest scale change

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brought about to the healthcare system of the country after the Affordable Care Act in 2010
(Clough & McClellan, 2016). According to Pullen (2017), international comparisons of the
healthcare system of US would find that the country spends more per-capita than other
developed countries but fails to achieve the same health metrics as theirs. This indicates that
the US healthcare system is inefficient and needs urgent reforms at the core of it. Moreover,
the country has major underinsurance and impending unfunded liabilities from the social
insurance programs and ageing demographic. Medicare and Medicaid contributed
significantly to this issue.
Motivating factors
The fiscal and human impact of the mentioned issues acted as the motivating
factors behind the Medicare Access and CHIP Reauthorization Act of 2015. The MACRA’s
primary provisions are increased funding, changes to the way Medicare physicians are
reimbursed and extension to the Children's Health Insurance Program (CHIP). A significant
change that has been brought about due to MACRA relates to the use of health information
technology. MACRA related regulations address incentives for the use of advanced health
information technology by healthcare providers. This has evoked a positive change in the
way in which care is delivered across settings promises to bring along better patient
outcomes. The Secretary of the Department of Health and Human Services (DHHS) is
supposed to implement the Merit Baed Incentive (MIP) program that consolidates three
incentive programs into one.
Effects of the trending legislation on health care overall in the United States and one
type of health care setting
The overall impact of the legislation has been drastic when speaking on a national
level. The country is set to undergo a transition from a ‘fee for service’ system to a ‘pay for

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performance-based system’. The ‘fee for service’ system allowed healthcare providers to bill
Medicaid and Medicare for all services provided. This novice approach would now entail the
provider to give out information on the quality of service, its value, and accountability to the
patient population (Obama, 2016). MACRA has been impacting hospitals across
communities.
Changes in your selected health care setting
As MACRA is making a mark on the health care system in the US, physicians are
aligning themselves with organisations that provide required support for addressing
challenges as well as opportunities presented by the legislation. Hospitals such as Johns
Hopkins Hospital has been employing physicians as well as other healthcare professionals
and are ready to bear the expense of implementing compliance with MACRA.
How stakeholders have been affected
The impact of integrating MACRA is vital for both physicians and service users.
Changes in physician reimbursement due to MACRA have a fair impact on the market value
of physicians. If the care professionals are not able todelvierhigh quality care, they suffer
reimbursement penalties. This has a negative impact on the physician compensation values
as well as the hospital. Simultaneously, there is a positive impact on the good performers as
they earn bonuses for crossing the performance threshold. The bonuses result in more
revenue ad drives up the bottom line for the hospital (Young and Kroth, 2017).
Conclusion
In conclusion, MACRA has brought about a major change in how healthcare system
functions in the US. As hospitals assume more risk for supervising and handling health care

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of the population, there is a need to ensure that compliance with MACRA does not lead to
meaningless engagement negatively interfering with patient access to care.

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References
Clough, J. D., & McClellan, M. (2016). Implementing MACRA: implications for physicians
and for physician leadership. Jama, 315(22), 2397-2398.
Obama, B. (2016). United States health care reform: progress to date and next
steps. Jama, 316(5), 525-532.
Pullen, L. C. (2017). MACRA Is Here to Stay. American Journal of Transplantation, 17(3),
591-592.
Young, K. M., & Kroth, P. J. (2017). Sultz & Young's Health Care USA. Jones & Bartlett
Learning.