New rules for physician payments through Medicare went into effect on January 1. Here’s what you need to know.
In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law. The legislation called for significant changes to how physicians are paid for treating Medicare patients. It repealed the Sustainable Growth Rate formula and replaced it with a program meant to reward physicians for “quality” of treatment instead of quantity.
In October 2016, the Centers for Medicare and Medicaid Services (CMS) released the (over 2,000 page) final rule implementing this system, which went into effect on January 1, 2017.
The rule calls for physicians treating Medicare patients to begin taking part in either a merit-based incentive payment system (MIPS) or an advanced alternative payment model (AAPM).
Most physicians will qualify for MIPS (CMS estimates that only 5-8% will be participating in an AAPM). Under MIPS, physicians’ payments will be positively or negatively adjusted based on “performance” in four categories: “quality,” resource use, clinical practice involvement, and advancing care information (see this primer for more details). The maximum up-or-down payment adjustment will be 4% the first year and increase each year thereafter, reaching 9% in 2022.
Improving the “quality” of physician care may sound like a laudable goal, but who exactly is to decide what is best “quality?” There’s good reason to believe this new system will not improve actual outcomes—in fact, many federal programs achieve the opposite of what is intended. One thing is certain. It will give the feds and the American Medical Association (AMA) even greater control over the practice of medicine, even though by law, medicine is supposed to be regulated not at the federal level, but at the state level.
Here’s the bottom line: doctors treating Medicare patients will need to abide by what the government thinks is “quality” care, or at least says it is (what the government actually thinks and says can be quite different). This, is turn, will be heavily influenced by the AMA, which represents a small percent of US physicians. And it will also be heavily influenced by what the usual special interests—insurance companies, hospitals, drug companies, and trial lawyers—want.
The AMA, as we all know, has a very narrow view of what “quality” care is, given their hostility toward natural medicine—or indeed, toward any approach to medicine that doesn’t conform to their drug-or-surgery standard or increase their income. Doctors and their patients, not the government, should determine what “quality” is in medicine. Indeed, only doctors and their patients can even define what medicine is or is not!
There are other problems. MIPS relies heavily on self-reporting, which leaves the system wide-open to abuse. A similar rating system based on self-reported measures was implemented to compare nursing homes, and news reports found that the system was easily gamed. Actual patient experiences diverged sharply from a nursing home’s rating. This gamesmanship occurred even in the absence of the strong financial incentives that exist in MIPS.
Complying with MIPS will also significantly increase the administrative burdens on physicians who already spend much of their day filling out paperwork. A study in the Annals of Internal Medicine found that “for every hour physicians provide direct clinical face time to patients, nearly two additional hours is spent on EHR and desk work within the clinic day.” This will get even worse with MIPS.
This is only one more disincentive for doctors seeing Medicare patients. We have outlined many others, such as the risk of going to jail for a minor and inadvertent billing error. What doctor would want to serve Medicare patients in this climate?
On the other hand, doctors know that it is really insurance companies, not the government, that administer Medicare day to day. Who can doubt that the insurance companies will first apply MIPS to Medicare, then try to extend it everywhere?
Other articles in this week’s Pulse of Natural Health:
Natural Products Championed in Congress
When is a GMO not a GMO?
Another Alzheimer’s Drug a Huge Flop
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Just get the government out of my health care! Yet again, some unelected, uncaring and probably undereducated bureaucrat will be deciding terms and conditions for me and my doctors
Does “practicing medicine without a license” ring a bell, here?!?!
When gubbermint/legislators (forcing vaccinations on EVERYBODY) does it, it’s OK. When ANYBODY else does it, they get PRISON TIME!!!!!!!!
Oversimplifying and obfuscating. Follow the money.
Your ‘friends’ in private healthcare (sickcare) don’t give a squirt about you. They are trying to separate you from your wallet, and largely succeeding with the help of their bought cronies in gov’t. So-called ‘Obamacare’ was a Heritage Foundation plan implemented in Vermont by Mitt Romney with the blessing of the for-profit sickcare industry, it is not govt healthcare. Much of the law was written by America’s Health Insurance Plans’ star lobbyist, Liz Fowler. They have gotten what they (you) paid for. They took your sky-high premiums and bought themselves hundreds of billions in additional profit in DC.
The only affordable healthcare solution that is known to the people of planet Earth, is a non-profit, single-payer system, with no middlemen, CEO bonuses, advertising costs, fancy vacations and dinners for doctors and politicians, and armies of highly paid lobbyists. The rest is more of the same American-style profiteering.
Under the 2017 new law, government employees can be cross examined, fired and given pay cuts at Congressional hearings. The swamp stinks !
You may shout at the government but when in all actuality it is Big Insurance and Pharmaceutical companies that run the show, politicians are just their paid puppets!!!
All 3 share the guilt equally ..big pharma, insurance and the government all profit from this obscene system. We are forced to buy into it under penalty of law. Get the government totally out of it. Stop paying for illegal aliens’ medical care would be a step in the right direction. And to Michael18000, socialism doesn’t appeal to me at all, especially involving my healthcare.
You mean providers will actually have to show a history of curing people? Horrors!
First we hear that homeopathy, chiropractic and naturopathy are scams and next bureaucrats become unwilling to hand them tax money. How cruel! UNELECTED medical boards and staticians decide what treatments to compensate just because they have degrees and research. Haven’t they ever heard of faith healing?
A recent study in Australia found that vegetarian/vegan diets DON’T decrease mortality. A recent report in the BJSM recommended that low-carb-high-fat diets be prescribed over high-carb-low-fat diets because they are more effective against degenerative disease.
How dare those evil feds discriminate against treatments just because they have no scientific support!
It depends on how one defines by “curing” people. Is it removal of symptoms? Is it ridding the body of all traces of disease?
The medical monopoly wants people to do only what they recommend because they like the benefits of being a monopoly. There are several studies which have demonstrated that perhaps 50% of all medical research is bogus.
Human beings have every right to choose how they want to maintain their bodies and then they accept that actions have consequences.
And, what is your point about vegetarian diets? New research refutes current gospel on a regular basis. It can take 40 years from the refutation to the change in medical practice. Major “health” organizations like the American Heart Association recommended choosing margarine over butter long after the research showed the toxicity, which was at least by 1960.
He has no reply because he is a moronic shill who has no idea how the real world works.
Your bought and paid for Big Pharma “science” is not much, if any, better and it costs hundreds of billions of dollars. Go shove it up your rear end.
Thanks for your thoughtful and well-researched reply. You appear to have consumed all of your ammunition without having harmed your target.
My “science” is largely government funded. “Alternative medicine” has also been government funded. The U.S. has an office for that. The funded studies seem to to disappear without ever reporting any results. Most would judge them to be scams.
You offer no technical expertise, only a quasi-religious faith. I will grant your right to choose your own fate based on that but not to impose ignorance on others.
I have results. Not ignorance.You support a completely unsustainable system.
I see what you mean by the response below. Maybe just a Pharma troll.
Or just someone young, stupid and naive.
Trust the Lord Jesus, He alone heals.
The Lord guides good doctors. The Apostle Paul’s good friend was Dr.Luke… Paul told Timothy to have a little wine with his water for his stomach problems. God gave us herbs and plants.
Yes the Lord has given the doctors wisdom. But they can only go so far. He did, give herbs, but ultimately if you do not find a way to get healed, by His stripes we are healed. Isaiah 53
The stripes healed us from being lost and without fellowship with God. The relationship God created man for has been healed. That healing is eternal. The healing of the body is temporal…. and our bodies are now seen as dead to God. We have been crucified with Christ. Yet, for our sakes God will heal … He has guided me into physical healings of great magnitude. But it required knowledge. For without knowledge His people perish. No “hocus Pocus” of waving a magic wand and instant healings while remaining ignorant of knowledge of God’s Word. Yes..God can sovereignly touch and heal. I have had that,too! But, when David declared that God healed all his diseases? (Psalm 103:2-4) There were no miracle healings being performed that time. We need to start dividing the Word correctly…Being a Workman not needing to be *ashamed.” Rightly handing the Word of God.
Good luck with that one.
The Lord has given the doctors wisdom. But they can only go so far. He did, give herbs, but ultimately if you do not find a way to get healed, by His stripes we are healed. Isaiah 53
There is only one kind of “healing?” Ever hear of a couple having their marriage healed? By His stripes we have been healed ETERNALLY back to being into relationship with God. These “stripes” people make God sound so superficial and a witch doctor. GOD REQUIRES KNOWLEDGE and UNDERSTANDING of His WORD! Or, we will perish! Death through poor health is one means to perish.
“My people are destroyed for lack of knowledge;
because you have rejected knowledge.” (Hosea 4:6a)
To say we are healed (physically) by His stripes if to be deficient in accurate knowledge. Lot’s of damage I have seen come to those who wander into that area of thinking that shows a lack of understanding and a need for over-simplicity because they hate discipline required to study and do their homework required of God for us to overcome the world’s ways and thinking.
1 Bless the Lord, O my soul;
And all that is within me, bless His holy name!
2
Bless the Lord, O my soul,
And forget not all His benefits:
3
Who forgives all your iniquities,
Who heals all your diseases,
4
Who redeems your life from destruction,
Who crowns you with lovingkindness and tender mercies,
5
Who satisfies your mouth with good things,
So that your youth is renewed like the eagle’s.
6
The Lord executes righteousness
And justice for all who are oppressed.
7
He made known His ways to Moses,
His acts to the children of Israel.
8
The Lord is merciful and gracious,
Slow to anger, and abounding in mercy.
9
He will not always strive with us,
Nor will He keep His anger forever.
10
He has not dealt with us according to our sins,
Nor punished us according to our iniquities.
Psalm 103
His Purpose? When David wrote that there were no miracle healers running about. God was healing all his diseases just the same. Ever realize that God heals through KNOWLEDGE? Learning and knowing what heals? David was healed before the faith healers entered the scene. And, Paul lost his ability to miracle heal after he became established as being from God. He recommended that Timothy drink a little wine with his water for his stomach ailment. You ever read that? Its found in 1 Timothy 5:23. And, how Paul had to pray for mercy from God because his good friend Epaphroditus was sick and Paul thought he would maybe even die. Ever read that? Philippians 2:25-28…. And, what about Paul having to leave behind Trophimus sick in Miletus? 2 Timothy 4:20…
Some Christians have got to stop being stubborn and accept correction when its stated in the Word. Otherwise? They become just as irrational and stupid as the Trump protestors. Just like the stupid and irrational Black Live Matter protestors. Correction is needed in the Church today! We need TRUTH! Its what will will make us free of deception and will make us free to live with joy and peace in the Devil’s world.
You mean the Jesus who thought that disease was caused by “demons” and never mentioned microorganisms? You say God gave us herbs and plants. Agreed and they can work wonders in maintaining health. Oddly, Jesus never mentioned what herbs. We had to figure that out for ourselves.
You really think that we figured out all of things by ourselves? Ask Jesus to show you who He is, He will.
As usual, the system is under the control of the insurance industry and the AMA.Big Pharma will also have a huge say.Meaning that a philosophy of maintenance medicine, drugs that mask or control but never cure or even aim to cure what ails us will dominate.Natural substances, which cannot be patented, will be of little or no interest.Actual cures are anathema to the pharmacy industries maintenance approach.
Gee what can go wrong here-only everything! Give us back our healthcare based on doctor-patient relationship. Keep bureaucrats out of my health care!
I’m surprised that Doctors even want to go to work in this country. Many are turning to Concierge coverage and staying clear from the HMO and Medicare markets. You can’t hire four paper pushers and expect to make a profit to give quality care. It’s a shame what all of our over paid governmental officials have done to this country. I think it’s time to start unwinding the city, county, state, federal and international officials and replace them with volunteers.
Maybe with a little artificial intelligence and voice recognition, the doctor eventually won’t need to do so much paperwork. That is really where the investment needs to be done.
Thanks to Obama for this. As usual.