Changing The Way Medicare Pays Doctors | Forbes

Cutting the reward money

But small physician practices and even larger groups with few Medicare patients may opt out of the new payment system.  CMS is also said it wants to experiment with excluding physicians in Medicare Advantage managed care plans from MIPs participation.

As a result, reports the online journal Modern Healthcare, the amount of money available to reward physicians is shrinking. It cites estimates from the physician trade group AMGA (formerly The American Medical Group Assn) that while doctors were eligible for $833 million in MIPS incentive payments in 2019, the new rules could reduce those payments to $118 million in 2020. Thus, MIPS participants can expect a maximum pay increase of just 2%, much less than the 7% first envisioned by MACRA.

The new rules also require greater price transparency for hospitals. They’d be required to post prices on the Web and CMS said it is seeking additional ways to make patients more aware of what a hospital stay costs.

It is hard to know what all of this will mean for patients. Doctors will push back hard on the proposed payment reductions, and some may get scaled back. Moving to a value-based payment system could, in theory, benefit patients who would receive better, instead of more, treatment. But the new rules may have the practical effect of slowing, rather than enhancing, that transformation.

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Changing The Way Medicare Pays Doctors.