The Centers for Medicare & Medicaid Services (CMS) outlet a complete review regarding its $91 billion funding through which payments are performed to physicians, transportation services, laboratories, and any related entity of sorts.
For 2014’s Medicare Part B, the ones that got the better payments were internists, as they received a total of $9.2 billion, resulting in $89,000 per provider. In the second place, there are the ophthalmologists, who received $4.2 billion after taking into account the drugs to be administered in the physicians’ office, which account for the significant amount of $2.1 billion.
Disproportionate earnings guidelines
The controversy rises amid the issue that physicians’ drug payments are being fully reimbursed by Medicare, and not only that, but they’re reimbursed at 6 percent above the market price. CMS is currently weighing the possibility of removing the profitability of prescribing expensive drugs to patients.
On average, the most expensive drugs covered by Medicare Part B were Lucentis and Eylea, both being important drugs in treating macular degeneration. The Lucentis intraocular solution costs at least $1,200 for 0.05 millimeters, easily reaching over $2,000 per treatment. But a similar medication is known as Avastin, which according to many doctors acts just the same as Lucentis costs less than $150 per treatment.
Merit-Based payments
Although there are clear discrepancies about who benefits from the general measures, according to physicians, the new compensation plan proposed by Medicare will harm smaller medical groups and independent clinicians.
The new guidelines are based on a Merit-Based Incentive Payment System (MIPS); it states that there will be performance bonuses of at least 4 percent for efficient clinical attention, but institutions that are not able to comply could be penalized for another 4 percent.
This is especially harmful to practices that become overwhelmed by patients and do not have the enough support staff to meet the performance expectations. According to current data, over 80 percent of independent clinicians will get penalized due to this measure.
The MIPS will take into account quality, advancing care information, clinical practice improvement activities and resource use/cost ratio. The new measures will take effect on 2019 and it will use 2017 as a pilot for the program.
Sources of income will be affected by the new measures, as providers will be receiving lesser earnings, which will surely limit their current state of expenditure. The government argues that the current reimbursement procedure has doctors prescribing expensive drugs whereas other brands and generics are able to perform the same functions. This is especially true for chronic conditions, in which the added cost of constantly buying the most expensive alternative quickly ramps up to thousands of dollars without the patient being able to do anything about it.
Source: Washington Post