Medi­care un­veils dras­tic over­haul of doc­tors’ pay

Kuwait Times - - HEALTH & SCIENCE -

WASH­ING­TON: Chang­ing the way it does busi­ness, Medi­care on Fri­day un­veiled a far­reach­ing over­haul of how it pays doc­tors and other clin­i­cians. The goal is to re­ward qual­ity, pe­nal­ize poor per­for­mance, and avoid pay­ing piece­meal for ser­vices. Whether it suc­ceeds or fails, it’s one of the big­gest changes in Medi­care’s 50-year his­tory. The com­plex reg­u­la­tion is nearly 2,400 pages long and will take years to fully im­ple­ment. It’s meant to carry out bi­par­ti­san leg­is­la­tion passed by Congress and signed by Pres­i­dent Barack Obama last year.

The con­cept of pay­ing for qual­ity has broad sup­port, but the de­tails have been a con­cern for some clin­i­cians, who worry that the new sys­tem will force small prac­tices and old-fash­ioned solo doc­tors to join big groups. Pa­tients may soon start hear­ing about the changes from their physi­cians, but it’s still too early to dis­cern the im­pacts. The Obama ad­min­is­tra­tion sought to calm con­cerns Fri­day. “Trans­form­ing some­thing of this size is some­thing we have fo­cused on with great care,” said Andy Slavitt, head of the fed­eral Cen­ters for Medi­care and Med­i­caid Ser­vices.

More path­ways

Of­fi­cials said they con­sid­ered more than 4,000 for­mal com­ments and held meet­ings around the coun­try at­tended by more than 100,000 peo­ple be­fore is­su­ing the fi­nal rule. It eases some time­lines the ad­min­is­tra­tion ini­tially pro­posed, and gives doc­tors more path­ways for com­ply­ing. The Amer­i­can Med­i­cal As­so­ci­a­tion said its first look sug­gests that the ad­min­is­tra­tion “has been re­spon­sive” to many con­cerns that doc­tors raised.

In Congress, staffers were por­ing over the de­tails. Rep. Tom Price, R-Ga., who wor­ries that Medi­care’s new di­rec­tion could dam­age the doc­tor-pa­tient re­la­tion­ship, said he’s go­ing to give the reg­u­la­tion “care­ful scru­tiny.” Sen. Or­rin Hatch, R-Utah, chair­man of a panel that over­sees Medi­care, called it an “im­por­tant step for­ward,” but said the ad­min­is­tra­tion needs to keep lis­ten­ing to con­cerns.

MACRA, the Medi­care Ac­cess and CHIP Reau­tho­riza­tion Act, cre­ates two new pay­ment sys­tems, or tracks, for clin­i­cians. It af­fects more than 600,000 doc­tors, nurse prac­ti­tion­ers, physi­cian as­sis­tants and ther­a­pists, a ma­jor­ity of clin­i­cians billing Medi­care. Med­i­cal prac­tices must de­cide next year what track they will take.

Start­ing in 2019, clin­i­cians can earn higher re­im­burse­ments if they learn new ways of do­ing busi­ness, join­ing a leadingedge track that’s called Al­ter­na­tive Pay­ment Mod­els. That in­volves be­ing will­ing to ac­cept fi­nan­cial risk and re­ward for per­for­mance, re­port­ing qual­ity mea­sures to the govern­ment, and us­ing elec­tronic med­i­cal records. Medi­care said some 70,000 to 120,000 clin­i­cians are ini­tially ex­pected to take that more chal­leng­ing path. Of­fi­cials are hop­ing the num­ber will quickly grow.

Sec­ond track

Most clin­i­cal prac­ti­tion­ers - an es­ti­mated 590,000 to 640,000 - will be in a sec­ond track called the Merit-Based In­cen­tive Pay­ment Sys­tem. It fea­tures more mod­est fi­nan­cial risks and re­wards, and ac­count­abil­ity for qual­ity, ef­fi­ciency, use of elec­tronic med­i­cal records, and self-im­prove­ment. Fi­nally, about 380,000 clin­i­cians are ex­pected to be ex­empt from the new sys­tems be­cause they don’t see enough Medi­care pa­tients, or their billings do not reach a given thresh­old. “Half of the physi­cian prac­tices un­der 10 (doc­tors) will not be re­port­ing at all,” said Slavitt. Ini­tially more doc­tors would have been cov­ered.

Ad­vo­cates say the new sys­tem will im­prove qual­ity and help check costs. But crit­ics say com­pli­cated re­quire­ments could prove over­whelm­ing. The ad­min­is­tra­tion says some doc­tors will be pleas­antly sur­prised to find out that re­port­ing re­quire­ments have been stream­lined to make them eas­ier to meet. With 57 mil­lion el­derly and dis­abled ben­e­fi­cia­ries, Medi­care is the govern­ment’s premier health in­sur­ance pro­gram. The Obama ad­min­is­tra­tion has also been work­ing to over­haul pay­ment for hos­pi­tals and pri­vate in­sur­ance plans that serve Medi­care ben­e­fi­cia­ries. The uni­fy­ing theme is re­ward­ing qual­ity over vol­ume.

While some qual­ity im­prove­ments have al­ready been noted, it’s likely to take years to see if the new ap­proaches can lead to ma­jor sav­ings that help keep Medi­care sus­tain­able. John Fe­ore of the con­sult­ing firm Avalare Health said it ap­pears many doc­tors are still un­aware of the mag­ni­tude of the changes ahead. “MACRA is a huge change in how physi­cians are paid, and there is a wide spec­trum on whether they are ready,” said Fe­ore. “By pro­vid­ing some op­tions and a tran­si­tion over a year or two, the (ad­min­is­tra­tion’s) in­tent is to al­low them to get com­fort­able.”

Medi­care also launched a new web­site with in­ter­ac­tive fea­tures aimed at ed­u­cat­ing doc­tors about the changes. Medi­care’s pre­vi­ous con­gres­sion­ally man­dated sys­tem for pay­ing doc­tors proved un­work­able. It called for au­to­matic cuts when spend­ing sur­passed cer­tain lev­els, and law­mak­ers rou­tinely waived those re­duc­tions. MACRA was in­tended by law­mak­ers as a new be­gin­ning. — AP

WASH­ING­TON: A sign sup­port­ing Medi­care is seen on Capi­tol Hill. — AP

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