The Centers for Medicare and Medicaid Services (CMS) unveiled Friday a 2,400-page-long regulation meant to thoroughly examine the way it compensates doctors and clinicians to pay them what they deserve based on quality. Health officials aim to provide cost-effective care by introducing bonuses and penalties that will affect 712,000 doctors and other clinicians starting in 2019.

Doctors will be paid new bonuses or receive penalties depending on their performance, which should include reports of data on performance, the use of electronic health records and cost management. Penalties can be avoided if doctors report quality data.

Doctors will be paid new bonuses or receive penalties depending on their performance. Photo credit: US News and World Report
Doctors will be paid new bonuses or receive penalties depending on their performance. Photo credit: US News and World Report

The government-sponsored health insurance programs for senior Americans serves an estimated of 57 million people across the United States. Medicare accounts for about one of every $5 spent on health care in the country.

As one of the biggest changes in Medicare’s 50-year history, it will take years for the complex regulation to be fully implemented. Under the previous, unworkable system for paying doctors, automatic cuts occurred when spending surpassed certain levels. Medicare used to pay doctors for the amount of visits received, as well as for the number of tests and procedures they performed. This method has been considered as an incentive for doctors to proposedly provide unnecessary healthcare.

The Medicare Access and CHIP Reauthorization Act (MACRA) has raised concerns that physicians in small practices would be negatively affected by the new regulation. But CMS officials have said doctors and other clinicians have the chance to avoid penalties in the first year, meaning they will have more time to prepare to face the new changes and pick their pace in transitioning the program. Officials have also remarked that the new rule makes it easier for doctors to participate.

“We know that small practices can provide the same high-quality care as larger ones,” said Dr. Patrick Conway, CMS’s acting principal deputy administrator, and chief medical officer, as officials announced the final rule, according to The Wall Street Journal.

Conway added that the “vast majority” of small physician groups have the potential to succeed under the new regulation.

How does it work?

There are two new payment systems for clinicians created by MACRA. Most of the medical professionals who bill Medicare are involved, including 600,000 doctors, physician assistants, nurse practitioners, and therapists. Next year medical practices will choose the system or track they will take.

By joining a leading-edge track known as Alternative Payment Models, clinicians have the possibility to earn higher reimbursements starting in 2019. They will be able to learn new ways of doing business as long as they are up for taking financial risks as well as compensations for high performance. They will also be required to report quality measures to federal officials and use electronic medical records.

Medicare estimated that some 70,000 to 120,000 clinicians would initially choose that challenging system and officials are hopeful that number will increase quickly, as reported by the Baltimore Sun.

The Merit-Based Incentive Payment System is expected to be chosen by 590,000 to 640,000 clinical practitioners. This second track offers more modest financial incentives, as well as accountability for efficiency, quality, self-improvement and those willing to take it will also have to use electronic medical records.

About 380,000 clinicians who don’t see enough Medicare patients are expected to be exempt from the new payment system. It may also occur that their billings don’t reach a certain threshold, according to the Baltimore Sun.

Critics and advocates so far

There has been a mix of MACRA reviews from medical-care providers. The Baltimore Sun informed that Maryland doctors at Greater Baltimore Medical Center and Mercy Medical Center said it would take them some time to review the changes before they could emit an opinion.

Gene Ransom, CEO of MedChi, represents a significant number of the state’s doctors and said it was a relief not having to worry about an annual Medicare cut. However, he noted that the majority of physicians would not be eligible for the advanced payment model and feared that a doctor’s job would become more complicated as a consequence of a system of valued-based payment.

“It is making it harder to practice medicine,” Ransom told the Baltimore Sun. “We understand what they are trying to do, but this is another large burden and another large cost to physician practices.”

But many doctors in Maryland are rather familiar with some aspects of the new Medicare system. Private insurers already offer programs similar to MACRA, as mentioned by Jonathan P. Weiner, who teaches health policy and management at the Johns Hopkins Bloomberg School of Public Health.

CareFirst BlueCross BlueShield is an example of that. The state’s largest insurer rewards primary care doctors for coordinating care with a patient’s specialists. It also compensates hospitals, so they improve care and cut costs.

Source: The Baltimore Sun