Doctors face stark choices under new Medicare pay proposal
The new draft regulations designed to change how Medicare pays clinicians represent the most sweeping overhaul the Centers for Medicare & Medicaid Services has made in a long time to the business of running a physician practice.
The goal is to have the vast majority of CMS funding flow through payment models that reward doctors for the quality of care they deliver, not just how many patients they see.
The changes have the potential to upend the way medicine is practiced today, accelerating the move toward hospital employment and making the small group practice a thing of the past. At the very least, the rule, once finalized, will inspire closer collaboration between doctors and hospitals, since physicians will have more incentives than ever to steer patients away from high-cost medical centers.
The CMS’ 962-page proposed rule is the first major step in hashing out the details of physician payment that Congress outlined in the Medicare Access and CHIP Reauthorization Act, the 2015 legislation that replaced the controversial sustainable growth-rate formula.
Clinicians will have to choose one of two paths: submit to the Merit-based Incentive Payment System (MIPS), or put a significant portion of their business into a qualifying Alternative Payment Model (APM).
Both carry financial risk for failing to meet program goals. The potential impact on physicians’ Medicare revenue under MIPS — which will apply to the vast majority of clinicians — would be as high as 4% in the first year, rising to 9% in subsequent years. The program goes into effect in 2019, but the first performance period begins on Jan. 1, 2017.
