Medicare Reimbursements: Who Knows Better How to Pay Docs Than Docs?


About a half dozen medical groups have stepped up to the plate and answered the Medicare agency’s call for ideas for alternative payment models.

The 2015 law that crafted a new Medicare value-based payment system scores medical professionals under a quality measurement system. They risk losing some of their claim reimbursements, depending on their score.

To avoid this—and possibly earn a 5 percent bonus—they can join one of the advanced alternative payment models that’s been approved by Medicare.

Starting Dec. 1, 2016, medical professionals were invited to submit their own payment model ideas for government approval. So far, the models that have emerged from this process have shown no lack of diversity.

A pulmonary medicine group in California, for instance, envisions a care model with beneficiaries using a smart phone application with color-coded alerts, an alarm clock and a panic button. A monitoring center would track input into the app.

Most of the submissions are of the niche variety—a payment model for professionals who serve individuals with advanced illness but who aren’t at the hospice stage yet, as another example.

The proposed models have to first get the thumbs-up from an 11-member body, known as the Physician-Focused Payment Model Technical Advisory Committee.

If the committee approves a model, it goes for review to the Medicare agency, which will respond on its website about whether the submission is at the level of an advanced alternative payment model.

Committee Vice Chairperson Elizabeth Mitchell told me thatallowing models from the medical profession offers the chance for practicing doctors to show what they believe is the best way to deliver better care at lower cost.

The committee’s door has been open for ideas during the past three months, and review teams are plowing through the first group of model submissions.

Five proposals is a healthy number at this point, Mitchell said, considering the amount of work it takes to put a submission together.

More ideas are cooking and the committee hopes this is just the beginning.

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