Week 8

I spent this week learning about MACRA, the legislation to be implemented in 2019 that will reward healthcare providers based on their quality of care. The Quality Payment Program makes Medicare better by helping providers focus on care quality and the one thing that matters most – making patients healthier. The Quality Payment Program ends the Sustainable Growth Rate formula and gives you new tools, models, and resources to help give patients the best possible care. Hospitals can choose how you want to take part based on your practice size, specialty, location, or patient population.

The push to pay for quality, not quantity in health care is rapidly accelerating. Doctors and hospitals are being evaluated on myriad quality metrics by rating services, insurance companies, professional groups and government programs—with results increasingly tied to financial penalties or bonuses.

But payers, providers and patients don’t always agree on what quality means, and there is no official set of standards.


The quality programs grew out of two realizations: Health care is unsafe and outcomes are poor. But there is no single measure of a doctor’s or hospital’s quality that will fix those problems. Instead, we’re measuring processes. Of the 123 different metrics in the government’s Hospital Compare website, 102 measure processes. That’s important, but it has become too burdensome for the benefit it delivers.

Quality should focus on the functional outcomes that mean the most to patients. For a patient who got a knee replacement, can she walk and climb steps? For a man having prostate surgery, can we operate without causing incontinence and impotence? To find the keys, and not just look in good light, we need to track and report functional outcomes across all patients by each team or hospital.