Sophie--did you see the medicare reimbursement changes?

[Benko]

I was curious your reaction to this:

http://www.lifezette.com/polizette/risk ... -medicare/

Before MACRA, Medicare used a fee-for-service payment system, reimbursing separately for each individual service provided, without regard to the quality of the care. The new system will reward doctors for providing high-quality, efficient care that leads to better patient outcomes, and penalize those who fail to do so. At least — that’s the idea.

[MachineGhost]

More meddlesome bureaucracy isn't going to reduce costs or improve quality. Medicare (and Medicaid) doesn't have a track record of getting rid of the bottom of the barrel scum compared to the power of a competitive free market, so why will now be any different? No, it'll just turn Medicare into a bigger boondoggle than it is already.

But hey, I could be wrong.

[Maddy]

Under an outcome-based reimbursement scheme, what possible incentive would there be to take on complicated cases, or those involving inherently poor prognoses?

The acronym GOMER comes to mind.

[curlew]

From the article....

The ultimate — and undeniably laudable — goal of the legislation is to base physician payments on the value of the care patients receive, rather
than the volume of services provided.

I can see how they could quantify "volume of services provided", but how in the heck do you evaluate the "value of the care patients receive"? If you went to the doctor and he/she ordered blood tests and found you had high cholesterol and prescribed a statin drug for it, how do you evaluate the effectiveness of that? Isn't that a scientific question about the effectiveness of statin drugs?

[Tyler]

If you went to the doctor and he/she ordered blood tests and found you had high cholesterol and prescribed a statin drug for it, how do you evaluate the effectiveness of that?

The political contributions of the parent pharmaceutical company, of course.

[Maddy]

Based upon what's been done in the past with respect to utilization review, the efficacy of treatment is almost always evaluated in terms of whether the patient comes back. A patient who is released from the hospital and who is rehospitalized three days later is a big problem for the bean-counters.

[MachineGhost]

Based upon what's been done in the past with respect to utilization review, the efficacy of treatment is almost always evaluated in terms of whether the patient comes back. A patient who is released from the hospital and who is rehospitalized three days later is a big problem for the bean-counters.

And dying from an adverse drug event isnt?

[WiseOne]

I saw the announcement, but I have no idea what it implies for actual practice and reimbursements. I'll have to wait for it to filter through the academic practice organization. That will presumably take a long time, perhaps years.

The fact that it is already anticipated to create new and significant documentation burdens on physicians is more than a bit concerning. However, with the last round of "quality measure" reporting, the university did a pretty good job of making it as simple as possible by boiling it down to a few checkboxes for us to click. I am presuming there will be a similar effort this time around, and some of the requirements may be met on an administrative level. That will of course add to the administrative overhead though, which will in turn result in added pressure on physicians to earn more $$, which will mean working longer hours, and sacrificing more scholarly activity and teaching. Which has been happening already, because many of those administrators are feeling their CEO oats and would like to squeeze more money out of the proletariat (which is us).

Meantime, though, expect that most smaller practices are going to drop Medicare. Kind of an obvious result. Why did Congress think this was such a good idea?

[WiseOne]

Under an outcome-based reimbursement scheme, what possible incentive would there be to take on complicated cases, or those involving inherently poor prognoses?

The acronym GOMER comes to mind.

Absolutely true. Not to mention that practices are being asked essentially to insure themselves, by having a large pool of patients which of course they're going to try to bias toward healthy to make themselves look good. This game can only be played by mega-practices.

What happens to the super-sick people is that they end up at academic medical centers. This has been happening for a while, so that there's been this emergence of a two-tier health system: a private system for the healthy, and public/academic system for the sick. Not a great way to divide costs.

[MachineGhost]

Meantime, though, expect that most smaller practices are going to drop Medicare. Kind of an obvious result. Why did Congress think this was such a good idea?

They had to pass it first to read it, remember? Honestly, if we're not in the twilight of socialism, bureaucrats and lawyers-cum-career politicians, I'm gonna eat my heart out. Enough is enough!!!