Medicare is proposing a significant & controversial change to how it pays doctors.
Since I oversaw Medicare during the end of the Obama Administration, I have been asked to comment.
Warning- Payment policy is wonky but important. Follow if interested.1/ nytimes.com/2018/07/22/us/…
Since I oversaw Medicare during the end of the Obama Administration, I have been asked to comment.
Warning- Payment policy is wonky but important. Follow if interested.1/ nytimes.com/2018/07/22/us/…
Today Medicare pays based on the severity of the clinical visit with up to 5 levels. So a doc who sees someone with cancer gets paid more than a more “routine” visit.
Instead Medicare is proposing paying the same for all visits (except more for a new patient). 2/
Instead Medicare is proposing paying the same for all visits (except more for a new patient). 2/
This change has a number of benefits:
-would pay primary care doctors more (vs specialists), good for overall health and prevention
-would reduce time doc offices spend on coding and billing
-should mean more time w patients 3/
-would pay primary care doctors more (vs specialists), good for overall health and prevention
-would reduce time doc offices spend on coding and billing
-should mean more time w patients 3/
But there are overarching negatives:
The principal one is that it takes a lot more time to see a patient with complex issues. It could easily lead to cherry picking (docs avoiding sicker patients, more challenging patients, lower income patients). 4/
The principal one is that it takes a lot more time to see a patient with complex issues. It could easily lead to cherry picking (docs avoiding sicker patients, more challenging patients, lower income patients). 4/
Patients with higher complexity and greater needs want to know their clinical team is getting paid to spend the extra time and will be rightfully concerned that they won’t get the time needed. 5/
Congress mandates that changes are “zero sum” so there is no way to make a change without a corresponding consequence. There is no perfect system. 6/
When I was at Medicare, improving health equity and integrated/team based mental & physical health were our top priorities.
But simplicity for patients and burden reduction for docs were critical goals as well. 7/
But simplicity for patients and burden reduction for docs were critical goals as well. 7/
A comment period is open. One thing for sure is that when income is affected, there will be strong opinions.
My mentions are filling with suggestions. But this can only be approved or not; new ideas that aren’t in the proposal can’t be added. 8/
My mentions are filling with suggestions. But this can only be approved or not; new ideas that aren’t in the proposal can’t be added. 8/
A final comment I should have probably put at the beginning:
These payment decisions are ones we need to make whether we have our current system or single payer.
PS. Watch the open season on lobbying. /end
These payment decisions are ones we need to make whether we have our current system or single payer.
PS. Watch the open season on lobbying. /end
