Practice Management > > Reimbursement– Use of “hybrid” payment design prompted
by Joyce Frieden, Washington Editor, MedPage Today March 6, 2024
Who is to blame for America’s damaged health care payment system? Witnesses and legislators primarily implicated Medicare throughout Wednesday’s Senate Budget Committee hearing on how medical care enhances health care effectiveness.
“Medicare’s cost schedule has actually developed this out of balance shipment system and medical care crisis,” stated Christopher Koller, president of the Milbank Memorial Fund, in New York City. “How much and how it pays is not providing worth for the Medicare program or its recipients. Medicare is the standard for all other payers, so this ineffectiveness is rippled through our whole health care system.”
Issues About the RUC
Koller specifically faulted the RVS [Relative Value Scale] Update Committee– referred to as the RUC– a group of medical care and specialized doctors selected by the American Medical Association that makes suggestions to Medicare concerning just how much to compensate for numerous Current Procedural Terminology (CPT) codes. He kept in mind that a 2021 report from the National Academies of Science, Engineering, and Medicine, composed by a committee on which Koller served, discovered that 90% of the RUC’s suggestions are accepted by the Centers for Medicare & & Medicaid Services.
“The cost schedule carried out by Medicare methodically cheapens medical care services relative to other services,” he stated. “This leads to a payment space in between medical care and other doctors that is broadened, driving what specialized medical trainees select and what graduate medical education programs health centers provide. Offered the five-to-one ratio of expert to medical care doctors on the RUC, these findings are not unexpected.”
Amol Navathe, MD, PhD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, concurred. “The present fee-for-service payment system produces a misalignment in between company rewards and client health,” he stated. “This causes methodical underinvestment in medical care. In specific, the payment rates in Medicare’s Physician Fee Schedule undervalue diagnostic services in favor of procedural ones. This is a concern throughout the charge schedule and intensifies the reward to offer more services by moving towards expensive ones. Therefore, Medicare costs increases without producing extra health advantages.”
The option, he stated, is to pay medical care practices under a “hybrid” design in which clinicians get both regular monthly payments for each Medicare recipient, changed for their level of disease, along with fee-for-service payments for picked services supplied at sees. “A hybrid payment design would enable practices to provide more patient-centered care, modification to more effective staffing designs, and utilize innovation like telehealth when it is effective and efficient,” stated Navathe, who is vice-chair of the Medicare Payment Advisory Commission (MedPAC) however was promoting himself.
Experience With Alternative Payment Models
Bob Rauner, MD, a family doctor in Lincoln, Nebraska who spoke on behalf of the American Academy of Family Physicians, discussed his experience with alternative payment plans such as the Medicare Shared Savings Program.
