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Medicare Revolution: Profiting from Quality, Not Quantity

39 pages23 minutes


One of the most controversial aspects of the Affordable Care Act, also known as Obamacare, was how the government measures the cost effectiveness and quality of care and factors it into the way doctors, hospitals and other providers are paid.

The decisions determine how Medicare and other big public health programs spend hundreds of billions of dollars each year and strongly influence the coverage decisions of private insurers.

This brief CQ Roll Call guide examines the twists and turns of the long “doc fix” journey and what happened in one of the biggest legislative achievements of 2015, which will wean health programs away from the existing fee-for-service system, and other attempts to deal with doctor pay.

Author Adriel Bettelheim, the managing editor of the CQ health team, along with CQ HealthBeat associate editor Kerry Young and heath care policy writer Melissa Attias, guide you through the new criteria and payment models, from penalizing doctors who don’t report quality measures to giving hospitals and health plans bonus payments for improved year-to-year performance.
The book also looks ahead to the impact of the change, exploring how the health care industry is reconfiguring itself and developing new delivery systems to adapt to this trend of value-based purchasing.

If you have an interest in health care payments, you need to read this ebook.

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