The future of medicine

     I know that the repeal and replacement of Obamacare and the Affordable Care Act (ACA) is one of the top initiatives of your administration. Healthcare experts have confirmed my belief that our healthcare system is broken. ACA and Obamacare is a failure that affects the end-users ability to keep and retain their doctors and get insurance at an effective cost manner. In a bi-partisan way, the Affordable Care Act has created an opportunity to look at the services being provided and tie ie them to measurable outcomes rather than the quantity of the service. Quality of care measurement is easier said than done, but the progress that has been made in the departure from billing quantity versus quality and value based reimbursement is one that should not be abandoned. MACRA and its component parts, MIPS and APMs, were passed with significant bipartisan support. While repealing or replacing Obamacare ACA, the new MACRA ruling creates a whole new framework to drive providers to value based care it is the best thing we have seen and to take a word from you, it would be GREAT for the America people. It will provide longevity to our key programs in Medicare and Medicaid and their sustainability in the long run, by mandating patient satisfaction while controlling costs. Quality of care measurement has bipartisan support and is a sensible start to place the patient first and also embrace value outcome-based medicine while repealing and replacing Obamacare.

The Centers for Medicare and Medicaid Services (CMS) released the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in early October 2016. The rule finalizes parameters of the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs), collectively referred to as the Quality Payment Program (QPP). The rule is a response to the old ineffectual system and devises a way to reimburse physicians fairly, control costs and improve the quality of care that benefits all stakeholders. Regardless of political or ideological opposition against MACRA, Mike Leavitt, former governor of Utah and HHS Secretary in the George W. Bush administration, said we must respond to the economic imperative to change. An unhealthy population with soaring medical costs is detrimental to the country's ability to compete.

MACRA is forcing the medical community and the providers look at the patient not only as a patient but someone that has the ability to impact their bottom line with the reporting of patient satisfaction. Being in healthcare, I can only tell you that the providers are human beings and they do have bad days. The simple fact that the patient has the power impact their reimbursement has pushed providers to look at all their employees and processes to key in on how to make the patient experience a meaningful one. MU and ICD10 have paved the way to collect these quality metrics and others while expanding on population health, allowing value based medicine to enter the 21^st century.

President Donald J. Trump I know that the idea is to repeal and replace Obama Care and the Affordable Care Act , but as mentioned there are some incredible areas that are overwhelmingly clear to have not been from one party or the other but have been a common thread for the people. These advancements are logical that they remain as part of your new repeal and replace, such as pre-existing conditions and the ability for young adults to stay in their family’s healthcare policy. The key metrics of MU, PQRS, CG-Cahps and H-Cahps with the new model of MACRA and MIPS be maintained as they give a voice to the patients receiving care and they begin to provide insight to best practice ideologies surrounding outcomes and their pricing. I am asking you to consider enveloping MACRA as a core element in your initiative of repealing and replacing Obamacare and the Affordable Care Act. These advancements are forcing the healthcare community to adapt to providing healthcare that is quality driven and measured with outcomes; giving a voice to patients that are directly tied to the financial performance of the providers. Finally this is bringing smart people to make smart decisions providing it at a cost less than it has been commonly done while still maintaining quality in the forefront for outcome measures.

We simply cannot return to the pre-ACA world of rapidly increasing costs and declining health outcomes. We must move forward, and I believe that MACRA is a step in the right direction—even with its difficulties. Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, said during the National MACRA MIPS/APM Summit in Washington, D.C. summit, "Health is not partisan." I agree with him.

Let’s Make American Healthcare Great!

By Mario Espino