Changes in the way Medicare pays doctors are forcing many small, independent, family-practice physicians to relocate, join larger groups, or become salaried employees of hospitals or health companies, Steven Findley reports for Kaiser Health News. The Medicare Access & CHIP Reauthorization Act, which has bipartisan support and lacks the political tension of federal health reform, "replaces a reimbursement system that was widely criticized by doctors and regularly ran into budget problems on Capitol Hill," Fondley writes.
"The law sets up two payment tracks," he reports. "All doctors must choose one, except for those who see too few Medicare patients or whose income from Medicare is too low." As part of one track, "Doctors choose to join larger practices or organizations called 'alternative payment models' that would be held accountable for the quality of care delivered by all the doctors in the organization."
On the other track, "Doctors whose performance and quality of care exceeds benchmarks get bonuses up to 4 percent of their total Medicare reimbursements," Findley writes. "Those will start in 2019, based on evaluations of care delivered in 2017, and will rise a maximum of 9 percent by 2022. By the same token, physicians who score poorly on quality benchmarks—which include requirements for the use of electronic health records—face penalties at the same levels. The amount the government spends on the bonuses—estimated at $833 million for 2019—must be balanced by the penalties, keeping the program 'budget neutral.' However, Congress also authorized an extra $500 million a year bonus pool through 2024 for doctors judged 'exceptional'.”
"Physicians’ concern is that the new payment system will put doctors in solo or small practices at high risk of incurring payment penalties and will push thousands into larger practices and alternative payment organizations," Findley writes. The American Medical Association and dozens of other physician trade organizations and every state medical association "said the system needs to be simplified and must 'accommodate the needs of physicians in rural, solo, or small practices in order to enhance their opportunities for success and avoid unintended consequences.' One of those unintended consequences, the AMA says, is that penalized doctors would limit the number of Medicare patients they see, or drop Medicare." (Read more)
"The law sets up two payment tracks," he reports. "All doctors must choose one, except for those who see too few Medicare patients or whose income from Medicare is too low." As part of one track, "Doctors choose to join larger practices or organizations called 'alternative payment models' that would be held accountable for the quality of care delivered by all the doctors in the organization."
On the other track, "Doctors whose performance and quality of care exceeds benchmarks get bonuses up to 4 percent of their total Medicare reimbursements," Findley writes. "Those will start in 2019, based on evaluations of care delivered in 2017, and will rise a maximum of 9 percent by 2022. By the same token, physicians who score poorly on quality benchmarks—which include requirements for the use of electronic health records—face penalties at the same levels. The amount the government spends on the bonuses—estimated at $833 million for 2019—must be balanced by the penalties, keeping the program 'budget neutral.' However, Congress also authorized an extra $500 million a year bonus pool through 2024 for doctors judged 'exceptional'.”
"Physicians’ concern is that the new payment system will put doctors in solo or small practices at high risk of incurring payment penalties and will push thousands into larger practices and alternative payment organizations," Findley writes. The American Medical Association and dozens of other physician trade organizations and every state medical association "said the system needs to be simplified and must 'accommodate the needs of physicians in rural, solo, or small practices in order to enhance their opportunities for success and avoid unintended consequences.' One of those unintended consequences, the AMA says, is that penalized doctors would limit the number of Medicare patients they see, or drop Medicare." (Read more)
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