It was only a couple of weeks ago that I was lamenting a slow health IT news cycle. Now I’m up to my eyeballs in things I want to write about.
The physician lounge is buzzing about the Medicare Access and CHIP Reauthorization Act of 2015, also called the “SGR bill” or “Doc Fix” bill. Unfortunately, most of them didn’t read beyond the AMA headline — “Medicare payment formula bites the dust” — to see what is really heading their way. Although they won’t be threatened frequently with Medicare payment cuts, the entire Medicare payment game is changing. For those who participate, there will be annual payment increases of 0.5 percent through 2019 and then a variety of other changes.
Although that’s certainly better than a cut, it doesn’t even keep up with inflation. Physicians can’t ask their suppliers to limit their price increases to 0.5 percent. Many hospitals and health systems that only offered employees that level of salary increase would see feet moving towards the door. AMA leadership is lauding it as historic legislation that “finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians.” Based on the discussion around the physician lunch table, anyone who thinks this is going to end uncertainty about physicians and Medicare might be confused.
I have to admit I haven’t read the whole thing, but rather several strategic digests and quite a few chest-thumping press releases. Colleagues who are savvier about the actual contents of the legislation are appropriately skeptical. Those that were considering a departure from Medicare haven’t changed course, and today, additional physicians were jumping into the discussion. Although Medicare’s quality reporting programs should be streamlined, many physicians still are not on board with pay for quality if physicians will continue to be graded on outcomes beyond their control.
Although the new payment models are voluntary, I can see employed physician organizations immediately heading in that direction. Administrative bloat will increase as teams are hired to review and comply with what will undoubtedly be reams of new CMS requirements and regulations. While physicians around the table were initially applauding the end of MU as we know it, the room became quiet when the detail-oriented ones pointed out its replacements. The more unified incentive program will be based on quality metrics, resource and cost utilization, practice improvement, and also Meaningful Use. Physicians in the so-called “Alternative Payment Models” will also have to continue using certified EHR technology, so vendors aren’t off the hook either.
Physicians are particularly leery of metrics that include untested patient satisfaction or engagement metrics. A piece in The Atlantic this week addresses the issue. My favorite quote: “Patients can be very satisfied and be dead an hour later.” It cites research by a professor at the University of California-Davis that concluded the physicians may be reluctant to have difficult conversations with patients due to fears of lower patient satisfaction scores. There’s not a tremendous amount …read more