Medicare Access and CHIP Reauthorization Act Essay

The Medicare Access and CHIP Reauthorization Act (MACRA) changed the way health care providers are reimbursed through Medicare, provided an increase in funding, and extended the Children’s Health Insurance Program (CHIP). MACRA placed conditions upon care providers in order for them to receive reimbursement: care must be quality care, i.e., care that helps them to keep from having to come back for more treatment—rather than just treatment after treatment, keeping patients coming back through the revolving door of medicine without every actually helping them. The type of quality care required by MACRA is preventive medicine and health literacy promotion. As Licthenfeld (2011) pointed out, too many doctors are diagnosing patients with health problems that are insignificant and do not need treatment—but because Medicare was always willing to bankroll treatment it made good business sense to treat every patient for every symptom. The problem is that people are like cars—as they age, they break down—that is just nature. Too much treatment can actually decrease the quality of the life of the patient, just as always having one’s care in the shop can make one wish one had a different care. MACRA was not only designed to save money for Medicare but also to increase the quality of life of patients by obliging doctors to increase the quality of care they provide instead of just increasing the quantity of care. Likewise, Glasziou, Moynihan Richards and Godlee (2013) have noted that too much testing and not enough care “worsens health inequalities and drains professionalism, harming both those who need treatment and those who don't.” This was another issue that MACRA sought to address.

The positive effects of the policy are that it reduces the emphasis on treatment and focuses instead of quality care. Many physicians adopt an attitude of “let’s fix everything wrong” even though that is not really needed all the times. Welch, Schwartz and Woloshin (2011) show that most professionals in health care “push the idea that the best way to stay healthy is to look hard for things that might be wrong” (p. 136). This leads to a type of over-treatment and over-diagnosis. Patients should instead be taught how to care for themselves, the importance of eating right, the value of exercising, and why they should get enough rest at night. Instead, care providers will use treatment services simply to increase revenue streams: for instance, it often happens that “health-care companies, hospitals, and some doctors advise people…

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…even better would be if it included a way for doctors to be reimbursed for essentially putting themselves out of business. The idea of preventive care is not going to appeal to every doctor because they see it as a threat to their business model. However, some health care providers could focus exclusively on prevention and Medicare could offer support, such as subsidies, tax credits and other incentives—just as the federal government offered subsidies and tax credits for electric vehicle manufacturers in order to get people interested in buying them. To provide quality care means to make better the health of the patient, which is what the point of MACRA is all about. It is not necessarily going to be about padding the pockets of doctors, which is why many do not want to embrace preventive care. If the government subsidized preventive care and health literacy initiatives and allowed these approaches to health care to be seen as revenue streams by doctors, they would become more attractive in their own right and the government could achieve the health outcomes it is interested in achieving. The more that doctors can feel supported financially in their approach to improving quality of life, the more likely they…