Kelley Erica, Lipscomb Rhea, Valdez Jennifer, Patil Nitesh, Coustasse Alberto
Author Affiliation: Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia.
Health Care Manag (Frederick). 2019 Jul/Sep;38(3):197-205. doi: 10.1097/HCM.0000000000000267.
The cost of health care within the United States has continued to increase, whereas the quality of patient care has generally decreased in some areas. With the continued use of Medicare's former physician reimbursement algorithm, termed sustainable growth rate, national expenditures within the United States have been expected to increase 5.6% annually. To modernize the delivery and financing of care, Congress has introduced the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which has permanently eliminated and replaced the sustainable growth rate. The purpose of this study was to review MACRA and its implementation to determine how it would financially impact rural hospitals. Two reimbursement pathways have been created for physicians under the MACRA. In addition, the financing and competition among facilities created by the act have been expected to impact physicians and health care organizations. Rural hospitals have been set to receive reduced government reimbursements and have been predicted to compete poorly with larger hospitals and health care corporations. Furthermore, the payment tracks available through the act have been projected to impact solo and small practice physicians negatively.
美国医疗保健成本持续上涨，而在某些领域患者护理质量总体却有所下降。随着医疗保险先前的医生报销算法（即可持续增长率）的持续使用，预计美国国内支出每年将增长5.6%。为使医疗服务提供和融资现代化，国会出台了《2015年医疗保险准入与儿童健康保险计划再授权法案》（MACRA），该法案已永久废除并取代了可持续增长率。本研究的目的是审视MACRA及其实施情况，以确定其对农村医院的财务影响。MACRA为医生创建了两条报销途径。此外，该法案所引发的医疗机构间的融资与竞争预计会对医生和医疗保健组织产生影响。农村医院预计将获得减少的政府报销，并且预计与大型医院和医疗保健公司竞争时表现不佳。此外，该法案提供的支付轨道预计会对个体和小型执业医生产生负面影响。
