New law’s success or failure will ‘profoundly influence the future of the U.S. health care system’ The Obama Administration has taken one last swipe at senior citizens and those that depend for Healthcare on Medicaid before leaving office and turning it over to, God forbid, Hillary Clinton. In what is probably the most devastating modification to the healthcare of most senior citizens and the poor since it’s inception in 1966, the Centers for Medicare and Medicaid Services (CMS) released the final rule for implementing the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA). And it is not good. The new Act dramatically changes how Medicare pays doctors for their services.
Its biggest effect on the program is how doctors get paid? And before you ask, yes it does matter. The success or failure of the new payment system will profoundly influence the future of the U.S. health care system. And while the goals may be laudable, as usual when government led by liberals gets involved, its implementation sets up the system for a catastrophic failure by introducing a number of unknowns raising the potential for unintended consequences for both patients and doctors.
Before passage of the new act, named MACRA, Medicare used a fee-for-service payment system ever since it was implemented in 1966. Doctors were reimbursed separately for each individual service they provided. But under the new system, Doctors will be rewarded not for the services, but for providing high-quality, assembly line, efficient care that should lead to better patient outcomes, and penalizes those Doctors who fail to do so. At least that’s the idea, though the reality may be very different.
MACRA creates two pathways for physician payment. There’s the Merit-Based Incentive Payment System (MIPS), which will pay doctors based on how they score on a number of performance metrics relative to their peers. The second pathway will reward doctors who participate in Alternative Payment Models (APMs) meant to promote high-quality, cost-efficient care by incentivizing doctors to work together toward a common purpose: improving patient outcomes while eliminating unnecessary spending.
While on paper, this may sound good, but all the emphasis on better quality care comes with a trade-off. To assess the quality of care provided by doctors in the MIPS pathway, the physicians will have to report on a number of measures that many feel do nothing to help them improve the care they provide. In other words, there is going to be a lot more paperwork that does nothing to help either the Doctors bottom line, or the Patients health care.
Since the inception of ObamaCare, Doctors are already devoting a considerable amount of time reporting on quality measures and your health to the federal government. In fact, a recent analysis found that a typical medical practice currently spends, on average, 785.2 hours a year per physician to track and report quality measures. That’s over 19 ½ weeks a year in time spent away from patient care. That amounts to more than $40,069 per physician on average. That is one reason you have seen office fees and co-pays skyrocket in the last 8 years. In addition, these costs present a particular hardship for small, independent practices operating on narrow margins. Moreover, three-quarters of the doctors surveyed felt that the measures did nothing to help them improve their care.
How much the new requirements will add to the already considerable burden of administrative requirement on physicians remains to be seen. And even though CMS has made some efforts to minimize the reporting requirements and has even allocated some funding to assist small practices in preparing, the effects are likely be substantial.
The ultimate goal of the legislation is to base physician payments on the value of the care patients receive, rather than the volume of services provided. And the Obama administration, always eager to “change” things that work into things that don’t, has set a rather aggressive timeline of tying half of all Medicare payments to value through APMs by 2018. But the administration fails to remember one rule of big government, inside every silver cloud lingers a dark lining. As yet, APMs have yet to fulfill their promise.
Accountable Care Organizations (ACOs), the best known type of APM, accept responsibility for the total costs of care for their patients. If the providers in an ACO can reduce health care spending below an established benchmark, while maintaining quality of care, they can share in the savings. But if spending is above that benchmark, they get stuck for the difference. Not surprisingly, even with higher copays and insurance costs, after four years, ACOs still haven’t generated the savings that many had hoped for.
This lack of profits for the ACO’s is cause for real concern for recipients of federal programs. If providers continue to be faced with increased reporting and administrative costs and their reimbursements and new payments for services continue to decline, it will put their income at risk. That drop in income for many doctors, especially independent practitioners, could feel at some point that they simply can’t afford to participate in Medicare any more.
In fact, one recent survey of physicians found nearly 40-percent expect a “mass exodus” from Medicare over the new MACRA. When you add that figure to the predicted shortage of doctors over the next decade and a population which is getting older all the time, this could easily create a highly dangerous situation over the next 10 years where only the rich and well connected can either afford or obtain healthcare.
If MACRA is implemented according to the arbitrary timeline set by the Obama administration, it could force doctors to abandon private practice for salaried positions or leave practice altogether. Neither of these situations would be tenable in the long run for the citizens of our country and Obama and his liberal supporters like Hillary Clinton will have succeeded in destroying the greatest healthcare system in the world. Maybe you should think about that on Election Day.
Lifezette.com contributed to this report.
©2016 R. L. Grimes, All Rights Reserved.