The Climate of Medication Reconciliation
The medication reconciliation climate includes six major U.S. Federal laws and competing initiatives that are impacting the healthcare industry, payment models and care delivery. This is supplemental material for the eBook Med Wreck: Proposing a Solution for the Nightmare of Medication Reconciliation, available free on this website.
This material summarizes these initiatives. Each has introduced significant change to physicians, hospitals and payors. Each also have a regulatory and financial impact on the industry.
What should we focus on today?
Throughout the past decade, healthcare providers, payors and solution vendors have devoted significant resources to address these competing priorities. Those of us in healthcare often feel like the lion eyeing the four legs of a chair held before us by the circus tamer. We sometimes become paralyzed as we decide which of these we should prioritize.
Thus we divert our attention from optimizing medication management and focus on the things that affect our reimbursement and our quality scores. Thus we have little time left to address our Med Wreck issues.
Time for a Breather...
Fixing the Med Wreck problem might require use to slow down the rate of change for these other initiatives. However, we hope to make the case that creating a single source of truth (SSOT) for medications will benefit every person in the United States, lower cost and improve outcomes.
MACRA, QPP, MIPS and APM
The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) took affect January 1, 2017 as Medicare's Quality Payment Program (QPP). QPP affects physician reimbursement under two options: Merit-based Incentive Payment System (MIPS) and Alternate Payment Models (APM).
The Protecting Access to Medicare Act of 2014 will take affect on January 1, 2018 (though delay proposed to 2019). It requires clinical decision support systems to confirm Appropriate Use Criteria (AUCs) on ambulatory (outpatient), non-emergent advanced imaging studies such as MRI, CT and PET scans.