Physician pay system rewards quality
Miscalculation shows new model undergoing growing pains
A key part in the way the United States is changing how it pays for health care is feeling some growing pains.
The grinding and stretching comes now just a few months before the government starts rewarding physicians for meeting performance standards and punishing those who don’t under the Merit-based Incentive Payment System or MIPS.
Participating doctors have been going through the motions for the last two years, self-reporting on whether and how well they meet performance standards. Whether they do determines if they get a boost in Medicare Part B reimbursements or pay a penalty.
However, an error in how the Centers for Medicare and Medicaid Services calculated doctors’ 2017 scores, now being corrected, will change the amounts doctors thought they were to receive in bonuses or pay in penalties beginning next year.
The MIPS system is designed to be budget neutral, so it can’t cost Medicare additional money, explained Dr. Jaan Sidorov, president and chief executive at the Care Centered Collaborative, a for-profit arm of the Pennsylvania Medical Society that works as a liaison between private insurance companies and doctors to better define health care quality standards and how much meeting them is worth.
“The bonus money is spread like peanut butter across the entire population,” he said of the MIPS reimbursements to doctors. “Because those errors occurred in a budget-neutral payment program, everybody’s payments have to change.”
For many doctors, the change means they could receive a few thousand dollars less in their reimbursements.
“That’s not, from a business point of view, a whole lot of money,” he said. “We’re talking about single-digit percentage swings.”
The CMS is giving doctors until 8 p.m. Monday to request an individual review if they believe the agency made mistakes in calculating their scores.
What does all that mean for patients?
Directly, not much. The miscalculation represents another stitch in the nation’s glacial shift toward paying for good health rather than procedures and visits. The MIPS reimbursements represent a small slice of a participating doctor’s total income, but eventually, Medicare would like to see all health care paid for based on results.
The United States spends more on health care per citizen than any other country, more than $9,200 per person, according to research published last year and funded by the Bill and Melinda Gates Foundation.
The CMS see rewarding doctors for healthier patients, not simply for the number of procedures or visits they amass.
Since Medicare sets the pace for the national health insurance industry, insurers are certainly watching to see how other payment models succeed or fail, and in the case of MIPS, it would appear doctors are on board.
The CMS reports 91 percent of eligible clinicians are participating in the program. The agency currently is reviewing comments on proposed rule changes that, among other things, would open up the program to make more doctors eligible to participate in it.
The emphasis on results means patients will start, perhaps slowly and gradually, hearing more from their doctors. They’ll get more frequent reminders about vaccinations and preventive screenings such as mammograms and colonoscopies. They’ll get more instruction on taking prescriptions and reminders for refills, as well as more emphasis on healthy lifestyle changes.
Private insurers have been using value-based payment systems in select plans for years now, Sidorov said, and now that Medicare is pushing the matter, patients are likely to see more fresh ideas come out of the private sector.
“The thing about the commercial insurers is that in their relationships with physicians, unlike medicare, it’s not one-size-fitsall,” he said. “There are opportunities within that relationship for the physician community to work with the insurers to further refine how those measures are done and the dollars attached to them.”