DOCTORS SHIFT WITH PAYMENT RULES CHANGE
Driven to results more than quantity, but new system has pitfalls
@jayneodonnell USA TODAY
Tim Layman has high blood pressure but stopped taking medication for it more than two years ago because “it’s not really for me.”
“I believe there is a God that supersedes that natural order,” says the Rogers, Ark., pastor. “I’ve been made this way, and I’m not concerned about it.”
His doctor is. Mark Miller is worried about his friend and patient’s health, but he’s also concerned about his bottom line. Soon it will take a hit if the health of patients such as Layman does.
While Washington determines the fate of the Affordable Care Act, a less-known rule change overhauls how doctors get paid and the kind of health care they deliver. The rule, finalized last fall, replaced a much-criticized formula that put doctors at risk of annual double-digit pay cuts with one that links their payments to the quality of their service. Still, it’s hardly perfect. “I can make all the recommendations, but if the patient doesn’t comply, I may not meet the goals,” Miller says.
Miller supports the rule, which was part of the Medicare Access and CHIP Reauthorization Act (MACRA), and he is part of an effort to improve the quality of care and reporting in his area. He just finds some patients harder to treat than others, even in his relatively healthy area of Fayetteville near the Walmart headquarters.
“Some patients, because of diet and lifestyle, are going to have more heart attacks,” Miller says. “That makes me look worse than the quality of care I’m really trying to deliver to the patient.”
At 55, Layton gained insurance when Arkansas expanded Medicaid under the Affordable Care Act. Layton has decided to ignore low-fat eating: “Gravy and bacon are back on the menu for me.”
“The only concern I have about food is that at 255 pounds, I’m not trying to get any bigger,” says Layton, who is 6 feet tall. “I try to moderate how much I intake, but what I intake is of no consequence to me.”
Since the ACA’s passage in 2010, the Centers for Medicare and Medicaid Services has tried to accelerate the move away from paying doctors and hospitals for the quantity of services to focus more on the actual results. The new rule consolidated several “merit-based” incentive systems into one that reduces the possible penalties doctors face while making them eligible for potentially larger bonuses.
Most doctors aren’t sure of what the new payment system requires of them, says Tom Giannulli, a doctor who is chief medical information officer of the physician software company Kareo. Miller, one of Kareo’s clients, is an exception.
“A lot of them are not clear on why (regulators) are doing it,” says Giannulli. “It’s for everyone’s benefit and so we can finance Medicare in the future.”
MACRA is “a really significant signal to the market ... that health care is fundamentally shifting,” says Jack Stockert, a physician