Home Forums Discussions General Discussion New Medicare Payment Scheme

I've been reading the latest update on the Medicare payment system in Medical Economics. Boehner and Pelosi worked closely on getting a reform model that could establish a legislative edifice before they retire. The new bill killed the SGR, but put in place an increase of 0.5% for the next five years. (This will not even keep up with inflation.) The new Merit based Incentive Payment System (MIPS) will roll togetehr PQRS, MU, and value based modifier programs. Non-reporting physicians will receive a 4% penalty in 2019 and up to a 9% penalty after 2022. These penalties will go to pay "top performers" (top 25%) from 4 to 9% increase. I calculate at an average of 3% inflation since 1990, reimbursements will already be down almost 20% at that time from the present. For non-reporters, it will amount to a 24% to 29% effective cut, or an 11% to 16% cut if you are a top performer. Note that their incentives do not account for inflation. Those of us still taking Medicare payments have 5 years to consider another model.

If I read it right you can either go to the MIPS model as above, or go to an ACO system. I think for the ACO system you have to have at least 25% of your patients in an ACO and you get a 5% bonus. Neither option is particularly attractive. With the ACO you are placing a lot of risk on the ACO performance which an individual physician won't have much control over.

Since reporting will be integral to either model we'll probably be checking a lot of little boxes either way. I think I'll be able to limp along to retirement though.

I think we will do OK if we insist on "quality" --

That is, get rid of any patient who won't cooperate with controlling weight, blood sugar, blood pressure or who can't move fast enough to get in and out of the office in 5 minutes. You can't waste time talking to people, and taking care of more than one problem per visit risks diluting quality of the interaction.

Give everyone every vaccination you can think of if they can't provide documentation of having received it (give them 10 seconds to produce documentation).

Get everyone colonoscoped; dismiss them from practice if they fail to comply with quality measures.

I probably overlooked some things, but we have almost a year to get our ducks in a row.

The future of medicine:

Doctors will be not-so-highly paid technicians. We'll simply sign off on [censored] and get our paychecks.

Yes, that is the default position.

I maintain it is demoralizing, self-defeating, poor patient care, and an insult to the profession of medicine. Our forebears insisted on a much higher standard, and we owe it to our patients and our profession to do the same.

Tom: right! We should just refuse to play their game. They have not included us in the decision making. We need to insist on patient care, our way. We are the doctors.

Or we could just consider other job opportunities.

Do you remember "duck and cover"? https://www.youtube.com/watch?v=IKqXu-5jw60

It defined my 2nd and 3rd grades.
We weren't going get hurt by the "Russians" and their evil atomic bombs!

I didn't believe in giving in to fear then, I don't believe in it now.

Please watch the video! It's a civil defense film from 1951.
Then check out "Atomic Cafe".

That's where the criminals in the "insurance industry" (read "protection racket") got their playbook.

Not sure what opportunities you are referring to..within or outside medicine? I refuse to leave medicine and am currently in FT private practice with more autonomy than I could possibly ever have in another practice setting. Yet even in what I consider an ideal practice setting, the delivery of health care is being forcibly eroded by influences that I think we are all continuing to underestimate.

Jon,
I think you're on to something...maybe my future is in public transportation!