DCMedical News: January 11, 2018
DCMedical News
Washington, D.C.
Thursday, January 11, 2018
THE BIG STORY TODAY IN HEALTH CARE
Doctor payment continues to “evolve,” past mistakes quietly interred, new promises unveiled.
DOCTORS
CMS (on the eve of the MedPAC meeting which may take action to recommend elimination of MIPS) has put forward a voluntary pilot which would qualify as an Advanced APM under MACRA. MIPS, or the Merit-based Incentive Payment System, and APM or Alternative Payment Models, are the two means through which physicians qualify for incentive/bonus payments under MACRA, the Medicare and CHIP Reauthorization Act. The 2015 Act was intended to replace the discredited SGR or Sustainable Growth Rate, (see Congressional Research Service Reports from 2014 here and here). The SGR, a creature of the 1997 Balanced Budget Act, was meant to make Medicare “sustainable.” Each year, as volume of total Medicare services increased, the payment rate to doctors under Medicare was supposed to go down. SGR was never implemented, except in 2002, and the “due bill”—the aggregate amount by which physician payments would have to plummet in order to keep Medicare “sustainable”—grew to 30%. One day before CMS would have had to implement a 30% reduction in physician fees—with resulting tumult among seniors and their doctors—President Obama had a signing ceremony for MACRA. Under MACRA, instead of physician payment rates going down (the SGR model, thank you behavioral economists), they remain more or less the same from year to year. APM (popular among specialists) or MIPS (more popular among independent practitioners and primary care physicians) would enable total payments (for those participating) to go up. Non-participant physicians would be left at the water’s edge, as bonus-achievers (generally physicians employed by large groups or large health systems, almost all of whom have higher charges, many with “facility fees” to accompany their site-of-service requirements) would receive rewards.
This new CMS APM offering is another “voluntary” bonus program, modeled after the BPCI or Bundled Payments for Care Improvement model. In addition to being voluntary, the “BPCI Advanced” as it is being called has a fixed target price, against which the performance of physicians will be measured.
MedPAC, meanwhile, is expected today to act on a staff recommendation to make “new MIPS” a voluntary program, as well. So CMS (the muscle) and MedPAC (the head, sort of) of Medicare reimbursement are moving to make voluntary programs which are widely seen, together with electronic medical records, as contributing to physician dissatisfaction and burnout. The exceptions among physicians are in large systems (professional or institutional) which have staffed up to cope with the Medicare experiments, often with representatives at health policy speaking events. Making the programs voluntary, rather than eliminating them altogether, is seen as a testament to the indisposition of Medicare (in modern times, at least) to pay retail.
Finally, the Quality Payment Program enters its second year with another bonus opportunity, advancing an electronic record system from 2014 to one from 2015. MACRA pulled physicians out of the “meaningful use” (MU) programs, putting physicians and hospitals on different bases for “quality” payments. MU will be recalled as a prominent feature of HITECH, part of the 2009 American Recovery and Reinvestment Act. MU and HITECH were born, in turn, during the 2008 Presidential campaign: one candidate was told that a RAND study predicted $86 billion in savings by compelling physicians to adopt electronic medical records, but was apparently not told that the RAND study had been paid for by vendors who would prosper with widespread adoption of such electronic record technologies.
See http://www.overregulationofmedicalpractice.org/ and, more generally, the work of The Physicians Foundation (http://www.physiciansfoundation.org/) and the many physician surveys sponsored by that foundation.
In any event, $35 billion later, with nobody having lost their job, MU is silently interred.
EVENTS & PUBLICATIONS, MEETINGS AND READINGS
Your (Remaining) January Calendar:
January 11: Kaiser Family Foundation, on Health Reform 2020, 8:30 to 3:00, 1330 G St., N.W., Washington, D.C.
January 11: MedPAC, continuing to Friday, January 12 (agenda here)
January 17: Reinventing Rural Health, BiPartisan Policy Center, 1225 Eye Street, Washington, D.C.
January 25: MACPAC, 1800 M. Street, Suite 650, Washington, D.C., and continuing to Friday, January 26
January 29: COGME, Bethesda, MD, Livestream at https://hrsa.connectsolutions.com/cogme-council/, also January 30
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Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com