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Medicare Part B

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Time to fix perverse incentives in Medicare physician payment

January 30, 2017by Robert Whitcomb in Uncategorized tagged , , ,

A piece in Health Affairs says:

“MACRA is indeed better than what came before, but it still leaves in place perverse incentives that threaten to undermine quality and access for Medicare beneficiaries.”

The authors describe: “what we have accomplished regarding Medicare physician payment and what still needs to be done under the new administration and Congress.”

They conclude:

”While MACRA was a step in the right direction and encourages positive practice changes and provider integration, policymakers have a long way to go in aligning payment models with high-value results. As shown above and predicted by the CMS Actuary report, MACRA can only be considered an interim fix; new legislation is needed to avoid the unintended consequences of current law. Inaction will negatively affect the entire Medicare Part B program with a corresponding impact on health care access and quality for America’s seniors.

“This is not the time for Congress to rest on the belief that its work is done, but to act now to stabilize the long-term viability of the Medicare Program.”

To read the article, please hit this link.

Some providers battle new Medicare drug-payment plan

March 11, 2016by Robert Whitcomb in Uncategorized tagged

pills

The Wall Street Journal reports that “Specialty physicians and other health-care providers have launched efforts to derail a federal proposal to test whether paying doctors less for drugs administered under a Medicare program reduces spending….”

“The administration says the proposal will help patients and won’t deny anyone access to drugs. But the reaction Wednesday suggested a major fight ahead, as specialty doctors, drug-industry groups and Republican lawmakers described the plan as ill-conceived.”

“Some cancer doctors want the proposal withdrawn because they fear independent practices will fold. Some said their reimbursements from the drugs barely cover their costs.”

“The bulk of the criticism targets a proposed reduction in how much providers are reimbursed under Medicare Part B, which includes drugs administered by doctors in offices and outpatient settings. Cancer centers and oncologists say curbing the rising pace of prescription-drug spending shouldn’t be handled by whittling away at their payments.”

“The Obama administration is in a tough spot. On one hand, Medicare Part B has been criticized for having perverse incentives—doctors get more money if they administer costlier drugs. Generally, under Part B, doctors are reimbursed the average sale price of a drug plus an additional 6% premium. Higher-priced drugs mean bigger profit.”

 

 

 

 

 

Coding and definitional issues sabotage ‘wellness visit’ reimbursement

September 4, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , ,

 

Launched with considerable fanfare, much of Medicare’s seemingly promised payments for “wellness visits” go  unclaimed because of difficult coding and definition issues.

As MedPage Today noted:

“A huge victory in primary care doctors’ quest for better Medicare payment came Jan. 1, 2011, or so they hoped.

“That’s when six pages of the Patient Protection and Affordable Care Act kicked in, authorizing three novel billing codes so that as many as 33 million beneficiaries enrolled in Medicare Part B could receive ‘annual wellness’ visits to help them thwart disease. Nationally, the amounts are significant, paying from $118 to $174 for each code, and possibly more in some locations.”

“But despite this potential largess for primary care, physicians have been slow to submit claims. For the third year of the new codes, only 12% of eligible beneficiaries had Medicare billings for these services, according to 2013 data from the Centers for Medicare and Medicaid Services.

“‘There’s a lot of money and services being left on the table because of the way Medicare has structured this,’ Joseph Scherger, M.D., vice president for primary care at Eisenhower Medical Center, a 48-physician practice in Rancho Mirage, Calif.,  told MedPage Today.

“{T}hese visits are different and separate, instead of being integrated into the flow of care. Now, there’s this awkward separatism that offices have to work around. Patients want to talk about their medical problems, but that ends up violating the intent of wellness visit.”

 

 

 

 

 

 

Medicare Part B changes may threaten clinics

July 14, 2015by Robert Whitcomb in Uncategorized tagged

 

Have folks in the healthcare sector  given much thought to the financial implications of planned changes in Medicare Part B?

For instance, what happens when the latest Medicare changes make patients pay more for their coverage, with higher co-pays and premium increases coming soon, and when Medigap plans no longer pay the annual Part B deductible for new enrollees starting in 2020?

And consider that President Obama’s proposed fiscal 2016 budget would lower reimbursements to physicians for the medications they administer in clinics and physician groups to 103 percent of Average Sales Price from 106 percent while requiring drug makers to give a specified rebate if the physician’s cost for the drug exceeds 103 percent of the ASP. The current ASP formula leaves many doctors buying essential meds for their patients at a loss.

Will these Part B changes force a lot of clinics and physician offices to close by leading many patients to reduce the number of their visits because of higher costs?

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