The final rule on the massive physician payment overhaul law came out on Oct. 14. Since then, interest and advocacy groups have been combing through the 2,400-page regulation and further clarifications are trickling out.
As a refresher, the Medicare and CHIP Reauthorization Act of 2015 (MACRA) aims to replace years of uncertainty around Medicare payments to physicians. It also revises requirements for health IT adoption and provides incentives for physicians to move towards value-based payments. Continue reading
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The Urban Institute and the Catalyst for Payment Reform have collaborated on a series of briefs about various forms of health payment reform. Over the summer we’ll look at some that are receiving a lot of attention from policymakers and payers.
Let’s start with capitation. The recent Centers for Medicare & Medicaid Services (CMS) announcement about Comprehensive Primary Care Plus (CPC+) isn’t a switch to a fully capitated system. But this five-year model, scheduled to launch in January, does offer a degree of capitation, and moves further toward shifting more payments to a per-patient fee. Let’s look at what Urban/Catalyst says about the benefits and drawbacks of a capitated primary care payment system. Continue reading
We’ve all heard the talk about how the health care system is moving quickly from fee-for-service payment to value-based care. Certainly a new payment model is needed, but what is the difference between fee-for-service and value-based payment?
As health care journalists we have a good idea about how FFS works, but what are the characteristics of new models in which physicians and hospitals are paid for delivering value? And how do payers define value exactly? Continue reading
A secretive committee of the American Medical Association exaggerates how much physician time and effort is involved in performing many medical procedures, according to an analysis of the committee’s work by journalists at The Washington Post.
That exaggeration skews payment in favor or physician specialists and at the expense of primary care physicians, according to the article by the Post’s Dan Keating (@dtkeating) and Peter Whoriskey (@PeterWhoriskey).
The claim that the committee overstates the time involved to do many procedures has been reported previously. What is unusual about Keating and Whoriskey’s analysis of the AMA’s 31-member Relative Value Update Committee is that they calculated the committee’s estimates of the time involved for physicians to do many procedures and found the numbers to be off by as much as 100 percent in favor of specialist physicians. Continue reading