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This seems like it should be good news for physicians…

Physicians will get a 0.5% pay increase each year for 5 years under a deal by a bipartisan team of House and Senate negotiators to repeal the sustainable growth rate (SGR) formula for physician payment under Medicare.
The part that caught my eye was
The bill provides a 5% bonus to physicians who receive at least 25% of their Medicare revenue from an alternative payment model in 2018. Alternative payment models include accountable care organizations, patient-centered medical homes, and others. The 25% threshold increases over time, according to the summary.
I looked up "alternative payment models" under the ACA, and found this.
Risk-based arrangements (i.e., budget-based contracting) payments are predicated on an estimate of what the expected costs to treat a particular condition or patient population should be. This includes capitation, bundled payments, and shared savings arrangements….The onus is on the physician to be able to manage expected utilization and related practice expenses for treatment. Success is based on the practice’s ability to control the health care expenses of the patient population so that they do not exceed the budgeted amount.
That seems a bit similar to the budget limits proposed under single payer.
Global operating budgets for hospitals, nursing homes, allowed group and staff model HMOs and other providers with separate allocation of capital funds.
I'm not sure if my perception of a similarity between these two proposals is correct.  From the original article:
The proposed system entails an unprecedented degree of healthcare micromanagement by the federal government, according to David Howard, PhD, health policy professor at Emory University in Atlanta.
I wouldn't call single-payer micromanagement of healthcare by the government. Of course the ACA is not anywhere near single-payer, but maybe the 5% bonus can get doctors to gradually get used to moving in that direction.

On a related note, in a recent article in the New England Journal of Medicine, Dr Casalino from Cornell suggests that we should "ask all physicians to commit to providing care for enough Medicaid enrollees so that at least 5% of each physician's practice consisted of Medicaid patients."

The problem I see with this idea is that it suggests if we commit to some arbitrary percentage of medicaid patients we would take, we have then fulfilled our professional and moral obligations. The Hippocratic Oath doesn't say we can comply just 5% of the time. A 5% campaign would send the message that the Oath is negotiable. Physicians should acknowledge that they are plenty well off  accepting Medicaid/Medicare patients (especially as specialists), and should be reminded of the commitment that they already made when they chose to pursue the medical profession.

The good news is that according to a report (pdf) from the department of Health and Human Services, the trend of physician acceptance is in the positive direction for Medicare. Unfortunately Medicaid payments are on the average about 60-70% of Medicare payments (although in some states they are even higher than Medicare). Instead of a 5% campaign, maybe we need to have a campaign to increase Medicaid payments, or better yet, extend Medicare/Medicaid to all citizens.

"Relying on the pure goodness of physicians will not work because there are not enough so oriented to meet the need."
I would like to think that is not true. If it is, it is a sad commentary on our profession. I wonder, at what point do we start to consider other people's problems as our own, and ask "is this the type of society I want to live in?"
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Comment Preferences

  •  So how is this going to be paid for? (1+ / 0-)
    Recommended by:

    An email from AARP said that the Dems were offering copays among other things that will negatively impact medicare recipients and if that's the case I'll be calling my representatives and urge them to vote against it.

    My invisible imaginary friend is the "true" creator

    by Mr Robert on Thu Feb 06, 2014 at 09:17:55 PM PST

    •  take it out of pentagon's budget (1+ / 0-)
      Recommended by:

      they seem to have lots of money laying around

    •  Don't know about the base rate, but... (3+ / 0-)
      Recommended by:
      Mr Robert, blueoasis, Sylv

      the bonuses are paid out of "loser" physicians.  In other words, they will establish a quality threshold score, with those below taking penalties and those above reaping the gains.  The only problem with that concept is that no matter how much physicians collectively improve care, enough of them will have to lose out to fund those on top.

      I think a better model is to reward for improvement from where you start the first couple of years, and then after that have a rising threshold you have to beat to get the bonuses.  But, if everybody hits the mark, everybody gets the bonus.

      It is ultimately paid for out of the savings from less unnecessary care and less necessary care because people are healthier and using less resources.

  •  You're conflating multiple separate issues. (1+ / 0-)
    Recommended by:

    1) 'Accountable care organizations' have nothing to do with single payer per se. They are a model for organizing care providers (doctors, nurse practitioners etc.) hospitals and other clinical resources into networks that can provide care more efficiently. The goal is to both improve quality of care and reduce costs by utilizing electronic health records and data-mining to identify obvious opportunities for savings and quality 'outliers' requiring improvement, among other things.

    2) Global budgeting, capitated payment models and other such schemes are an attempt to get away from the current 'fee for service' Medicare model that pays doctors more for doing more stuff, thereby providing a powerful incentive to do more x-rays, more operations, more interventions in general. It drives costs up without any commensurate benefit in better outcomes. Systems like Mayo in Minnesota have successfully provided better care at lower cost by following a global budgeting model. It shows great promise, but details really matter.

    3) Medicaid is very state-specific. In some states payments are so low and red tape so pernicious, it's financially ruinous for individual physicians to accept it. Some states (like NY) have experimented with things like Medicaid managed care by providing better reimbursement in return for organizing care to reduce admissions and ER visits, with mixed results.

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