2. Kristina M. Young, MS
Taught graduate courses in health care organization and health policy for students in the fields of public health, law and management for over 25 years
Former Executive Director of the Western New York Public Health Alliance, Inc.
President and Owner of Kristina M. Young and Associates, Inc.
Former Vice President for Research and Development for a teaching hospital system and Executive Director of its health, education, and research foundation

3. Philip J. Kroth, MD, MS
Associate Professor, the University of New Mexico School of Medicine
Director of Biomedical Informatics Research, Training, and Scholarship unit at the UNM Health Sciences Library and Informatics Center
Section Chief of Clinical Informatics in the UNM Department of Internal Medicine
Directs a post-doctoral research fellowship in biomedical informatics and a new clinical informatics fellowship for physicians.
Elected national chair of the American Medical Informatics Association Academic Forum for 2015

4. MACRA (2015) & ACA (2010): Separate, Complementary Laws
ACA Major Features
MACRA Major Features
Promote value over volume-based care
Expand coverage & control costs
Insurance marketplaces
Medicaid expansion
Define baseline quality insurance
Promote population health & prevention
Incentivize care coordination
Promote value over volume-based care:
Merit-based Incentive Payment System (MIPS)
Alternative Payments Models (APMs)
Standardize quality reporting metrics
Reauthorized CHIP through 2017
Shifts Medicare fee-for-service to APM incentive models by 2018

5. ACA Support & Opposition (Selected)
Individual mandate
46 M+ uninsured
Improves Medicare drug coverage
Medicaid expansion
Covers preventive care 100%
Individual mandate
Increases government role
Too costly
Increases Federal deficit
No malpractice reform
Employer mandate  job losses

6. MACRA Bipartisan Support (1)
Pays for value, not volume – rewards cost savings and quality care
Standardizes the quality reporting systems between existing programs
Subsumes the Meaningful Use Program
Physicians have two options: MIPS or APMs

7. MACRA Bipartisan Support (2)
Repealed flawed Sustainable Growth Rate (SGR) formula for Medicare physician reimbursement with AMA & other physician groups’ support (“Doc-fix”)
Republicans conceded $200 B cost offset with Medicare providers’ spending reductions & cost increases for high- earning Medicare recipients
Democrats conceded 2 year (instead of 4-year) CHIP reauthorization

8. MACRA Selected Highlights (1)
“Doc-fix” provides permanent, predictable physician Medicare reimbursement
MIPS composite score reimbursement adjustments (upward, downward or none):
Quality: 30%
Resource Use: 30%
Clinical Practice Improvement Activities: 15%
Advancing care information: 25% (Formerly “Meaningful Use” Prgm)
Adjustments are 2 years in arrears

9. MACRA Selected Highlights (2)
APMs not subject to MIPS adjustments
Annual lump sum payment based on 5% of previous year’s estimated aggregate expenditures according to fee schedule
For individual physicians, working for APMs is easier than dealing with MIPS

10. ACA Executive Order (Limited to Federal Budget Taxes & Revenues)
May eliminate:
Individual mandate & penalty (tax)
Employer mandate & tax penalty
Premium tax credits & cost-sharing subsidies in marketplaces
Medicaid eligibility expansion
Prevention & Public Health Fund
Federal revenues from, e.g. health insurers’ fees & medical device taxes

11. ACA Components Requiring Legislation to Change
Family coverage for children up to 26 years
Banning insurance denials for pre-existing conditions
Changing baseline quality of insurance
Reinstating annual dollar limits for covered benefits
Reinstating co-pays for preventive services

12. ACA: Repeal, Replace, Repair?
By 2018, Executive Order without changes in law may:*
Destabilize insurance markets
Drop 10 M people from non-employer market due to unaffordability
Drop 5 M newly Medicaid insured
Drop 3 M from employment-based coverage
Initially increase non-employer-based premiums 20-25% with 50% increase after subsidies eliminated
(Implementing changes requires significant time; requires adherence to “notice and comment rulemaking”)
* Per Congressional Budget Office, January 2017 report

13. Teaching Resources for Instructors and Students
The following provide continuous updates on the ACA and MACRA’s status with links to additional resources:
ACA:
MACRA implementation updates:
will-docs-hang-on/

14. Future Directions
ACA: Highly interdependent economic & program components; major changes require tortuous deliberations with clarity of implications for population, industry, & market
MACRA: Strong bipartisan support for continued push toward value & quality suggest survival in its substantially present form

15. Live Q&A Session Voice Your Question: Type Your Question: Press *1
Follow the prompt to record your name
The operator will open your line, in turn
Type Your Question:
Use the chat or Q&A box feature in the lower right-hand side of your screen

16. Sultz & Young's Health Care USA Understanding Its Organization and Delivery NINTH EDITION
Visit go.jblearning.com/HealthCareUSA to:
Request a complimentary instructor’s copy
Download sample chapters
Request access to instructor materials

17. Thank you for participating!
Sophie Teague Recorded webinar will be posted on the LinkedIn Public Health Faculty Lounge: