Affordable Care Act Case Study

The health care system in the United States has always a controversial topic. Objections regarding availability of quality and affordable health care have been raised and have been left without answers. The Patient Protection and Affordable Care Act was signed and became official in 2010, which gave many people hope for improving health care in the United States. The signed PPACA originated the reform that began a different direction for the healthcare system that stresses the importance of preventive health care services that led to the increase of patients in the physicians’ offices, bringing benefits for both patients and healthcare providers. The Affordable Care Act presented provisions that expand payments to physicians’ offices. The ACA …show more content…
ACO is a unit that is formed between primary care physicians and specialist or other health care providers. The medical providers who participate in ACO are qualified for creating the Medicare Shared Saving Program. The ACO who assemble quality standards and whose patients spend less than the ACO budget on their treatment receive half the savings back with another half going to the CMS (the Centers for Medicare and Medicaid Services). By choosing a two-sided risk model, ACOs are allowed to keep up to 60% of the share of savings, where they will be required to repay the qualified patients if their medical spending will surpass the budget mark. Although most medical providers who participate in ACOs have selected a one-sided risk model, according to this model they share the earned savings but are not supposed to pay a part of the share of the costs when spending goes over …show more content…
Such programs as Value-Base Payment Modifier and Physician Quality Reporting System are created to reach that goal. According to the ACA, physicians are required to have the Value-Based Payment Modifier program implemented by January 1, 2017. The VBPM will regulate physician payments depending on a combination of quality and expense measures. The VBPM rewards physicians who have better performance with higher payments and decreased payments of those physicians whose performance is low. VBPM is aligned with the Physician Quality Reporting System (PQRS). Physicians receive an evaluation based on quality facts that are accepted using PQRS. PQRS is a program that uses inducements and fines to urge qualified medical providers to report quality statistics to Medicare and it was originated by the Centers for Medicare and Medicaid Services (CMS). The health care providers who accept patients that are covered by Medicare insurance are required to join the Physician Quality Reporting System. PQRS allows health providers to evaluate the quality of health care patients are receiving from them, making sure the patients get the best care they can. Using PQRS, physicians also can track the quality metric and how often they reach it. Physicians who don’t take part in the Physician Quality Reporting System program are subject to a 2% fine in Medicare

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