Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
Doctors should step up and recommend more payment alternatives to fee-for-service Medicare, the HHS secretary said April 11.
Health and Human Services Secretary Tom Price said innovative payment models could work better than fee-for-service Medicare and might stop doctors from leaving the profession at middle age because they feel “burned out.”
Price, a third-generation doctor, spoke before the first voting meeting of the Physician-Focused Payment Model Technical Advisory Committee, created by a 2015 law to consider and recommend alternative payment models that would hold clinicians accountable for cost and quality of care. The innovative physician-focused payment models being considered by the committee are intended to move doctors away from the traditional pay system.
Rather than encouraging simply a high volume of services, the models are intended to offer a payment approach that can give doctors added incentive payments to offer coordinated and cost-efficient care in a collaborative setting.
Price said part of the burnout problem is the “one size fits all” Medicare model they must work under.
Doctors across the country should offer the committee ideas about what payment model would work better for them, the HHS secretary said. This is especially important for those in rural and underserved areas who think the current system is designed for large integrated groups that have administrative assistance, he said.
Price praised the half dozen groups that submitted models for the committee to decide whether to recommend for approval to the HHS.
The technical committee was created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a law that replaced Medicare’s sustainable growth rate formula.
MACRA offers medical professionals a payment system with two options—continue being paid under the Medicare fee-for-service system and be graded by quality measures that could result in payment cuts, or join an advanced alternative payment model (APM). Those who join an HHS-approved advanced APM are protected from cuts they might receive under the quality grading program and are eligible to receive a 5 percent bonus on their reimbursements.
The 11 members of the technical panel rejected one of the models that was submitted and recommended limited testing for two others.
Members said that a model submitted by the Pulmonary Medicine, Infectious Disease and Critical Care Consultants Medical Group Inc. of Sacramento, Calif., failed on two of 10 categories the panel uses to review ideas.
The Chronic Obstructive Pulmonary Disease (COPD) and Asthma Monitoring Project would have used such tools as “smart alarms” and a “panic button” to monitor patients’ disease and medication adherence through a smart phone application.
However, members said it didn’t measure up on committee criteria for integration and care coordination and payment methodology.
Two other models will be recommended to the HHS for limited-scale testing.
Project Sonar, submitted by Illinois Gastroenterology Group, is a care management program intended to improve the medical management of those with chronic disease, in part to reduce the cost of care. Some of the methods include assessing all patients using a “set of biopsychosocial measures,” and enrolling them in a “web-based communication platform,” such as through smart phones.
“We intentionally requested limited scale testing,” Lawrence R. Kosinski, managing partner of the Illinois Gastroenterology Group, told Bloomberg BNA April 11. “Our model has been implemented in patients” with inflammatory bowel disease, he said. “In order to fully deploy it, we need some limited scale testing in other chronic conditions,” he said.
The other model recommended for limited testing is from the American College of Surgeons-Brandeis Advanced APM. This model uses episodes of care to measure savings and losses and adjusts payment based on quality of care.
To contact the reporter on this story: Mindy Yochelson in Washington at MYochelson@bna.com
To contact the editor responsible for this story: Kendra Casey Plank at firstname.lastname@example.org
Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)