You have reached your limit of free articles this month.

Enjoy unlimited access to SpringfieldNewsSun.com

Starting at just 99¢ for 8 weeks.

GREAT REASONS TO SUBSCRIBE TODAY!

  • IN-DEPTH REPORTING
  • INTERACTIVE STORYTELLING
  • NEW TOPICS & COVERAGE
  • ePAPER
X

You have read of premium articles.

Get unlimited access to all of our breaking news, in-depth coverage and interactive features. Starting at just 99c for 8 weeks.

X

Welcome to SpringfieldNewsSun.com

Your source for Clark and Champaign counties’ hometown news. All readers have free access to a limited number of stories every month.

If you are a News-Sun subscriber, please take a moment to login for unlimited access.

Medicare unveils far-reaching overhaul of doctors’ pay


Brought to you by

Kettering Health Network

Changing the way it does business, Medicare on Friday unveiled a far-reaching 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.

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 leading-edge 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.

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.”

story text created on Friday 10/14/2016 at 5:11:24 pm by Paul Schaffer


Reader Comments ...


Next Up in Health

Tuna, star of the Amazing Acro-Cats, dies of cancer
Tuna, star of the Amazing Acro-Cats, dies of cancer

The cowbell won't sound quite the same now that Tuna, the star of the Amazing Acro-Cats cat circus, has died.Happy Cats Haven posted the news Friday on its Facebook page: "To all our fans of Tuna and The Rock Cats and the Amazing Acro-Cats, it's with many tears that we let you know that Samantha Martin's star kitty Tuna crossed the Rainbow Bridge...
7 small changes that will have a big impact
7 small changes that will have a big impact

It’s only a few weeks into 2017, but you’ve already come to an uncomfortable and familiar realization. New Year’s resolutions result in more guilt and depression than achievement. Forget about the big aspirations for a transformational do-over. They don’t work. How about making some small changes today that eventually can have...
Let’s have a cheer for the Amherst Hamsters
Let’s have a cheer for the Amherst Hamsters

Amherst, a tiny college of 1,795 really smart scholars in Massachusetts, made news last year when the board of trustees voted to drop Lord Jeffs as its athletic teams’ unofficial mascot. Lord Jeffery Amherst, historians discovered, was not necessarily a nice person. The 18th century British general reportedly once suggested giving smallpox-infested...
Stark numbers show heroin’s local grip
Stark numbers show heroin’s local grip

An average of seven Montgomery County residents a day were treated for drug overdoses by emergency departments in 2016, and one person alone made eight trips to the ER. Eleven people were treated twice in the same day for overdoses. The stark figures — amassed largely due to a devastating heroin epidemic — are found in a new Public Health...
After a cesarean, some women can have a vaginal birth

Premier HealthNet is one of the largest groups of pediatrics, family medicine, internal medicine, and urgent care practices in southwest Ohio. For more information, go online to www.premierhealthnet.com/news. Birthing a baby can be a long, painful process, but for many women the experience fulfills a deep emotional longing as a new mom. A vaginal birth...
More Stories