New Medicare model favors docs in large practices

Under a proposed new payment model for physicians, Medicare expects to favor large physician practices for bonuses, while practices with fewer than 10 clinicians bear the brunt of penalties.

According to Medicare, new performance measures take effect in January 2017. The agency says that “positive adjustments” and “negative adjustments” in pay, based on new benchmarks, will begin in 2019. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) set the parameters for this new payment model.

A chart from Medicare, available on our blog, shows the anticipated lopsided impact on small practices.

According to Medicare’s estimates:

  • Of nearly 103,000 solo practitioners, 87 percent can expect an average negative adjustment of $2,900 in 2019. Practices of fewer than 10 clinicians are likely to fare only slightly better.  
  • By contrast, in practices of 100 or more clinicians, 81 percent will likely receive positive adjustments averaging $1,800.

Medicare’s proposed changes would usher in a radical shift away from the current volume-based payment system to one of merit pay for doctors and other Medicare-eligible clinicians.  

Those participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs will be expected to meet 10 objectives, with Objective No. 1 being the protection of patient health information under information under the Health Insurance Portability and Accountability Act (HIPAA).

The American Medical Association (AMA) called the proposed new rules the “most sweeping change in physician payment policy in the last 25 years.” AMA said it would issue comments after a detailed analysis of the proposal.

Through June 27, Medicare will accept public comments on the new rule. 

Additional Resources from Medicare

Here are two summary sheets:

  1. A 14-page overview titled Quality Payment Program Fact Sheet
  2. A 6-page paper, titled Advancing Care Information, explaining proposals for the Merit-based Incentive Payment System (MIPS) performance category relating to the use of electronic health records. MIPS applies to Medicare Part B clinicians, including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

The proposed rules would replace the current Meaningful Use program.

Independent Reviews of the Proposed Rules

For quick highlights, you may view:

Five things to know about the proposed new rules from the website of the American Journal of Managed Care.

Physician payment in Medicare is changing: Three highlights in the MACRA proposed rule that providers need to know from the Brookings Institution.

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