In what may be the most significant modification to Medicare since the program began in 1966, on Oct. 15, the Centers for Medicare and Medicaid Services (CMS) released the final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It dramatically changes how Medicare pays doctors for their services.Does it really matter how doctors get paid? Yes — the success or failure of the new payment system will profoundly influence the future of the U.S. health care system. And while the goals of MACRA are laudable, its implementation carries a number of unknowns and the potential for unintended consequences — for patients and doctors alike.Before MACRA, Medicare used a fee-for-service payment system, reimbursing separately for each individual service provided, without regard to the quality of the care. The new system will reward doctors for providing high-quality, efficient care that leads to better patient outcomes, and penalize those who fail to do so. At least — that’s the idea.MACRA creates two pathways for physician payment. There’s the Merit-Based Incentive Payment System (MIPS), which will pay doctors based on how they score on a number of performance metrics relative to their peers. The second pathway will reward doctors who participate in Alternative Payment Models (APMs) meant to promote high-quality, cost-efficient care by incentivizing doctors to work together toward a common purpose: improving patient outcomes while eliminating unnecessary spending.This sounds good, but all the emphasis on better quality care comes with a trade-off. To assess the quality of care provided by doctors in the MIPS pathway, the physicians will have to report on a number of measures that many feel do nothing to help them improve the care they provide.Doctors already devote a considerable amount of time reporting on quality measures. A recent analysis found that a typical medical practice currently spends, on average, 785.2 hours a year per physician to track and report quality measures. That’s time away from patient care, and the costs — $40,069 per physician — present a particular hardship for small, independent practices operating on narrow margins. Moreover, three-quarters of the doctors surveyed felt that the measures did nothing to help them improve their careHow much MACRA will add to the already considerable administrative burden on physicians remains to be seen. To its credit, CMS has made some effort to minimize the reporting requirements and has allocated funding to help small practices prepare. Still, the impact will likely be substantial.The ultimate — and undeniably laudable — goal of the legislation is to base physician payments on the value of the care patients receive, rather than the volume of services provided. And the Obama administration has set a rather aggressive timeline of tying half of all Medicare payments to value through APMs by 2018.But a cloud lingers over that optimistic horizon: APMs have yet to fulfill their promise.Accountable Care Organizations (ACOs), the best known type of APM, accept responsibility for the total costs of care for their patients. If the providers in an ACO can reduce health care spending below an established benchmark, while maintaining quality of care, they can share in the savings. If spending is above the benchmark, they are on the hook for the excess. But after four years, ACOs still haven’t generated the savings that many had hoped for.This is cause for real concern. If faced with increased reporting and administrative burdens, declining reimbursements and new payment arrangements that put their income at risk, many doctors – especially independent practitioners – may feel that they simply can’t afford to participate in Medicare any more. One recent survey of physicians found nearly 40-percent expect a “mass exodus” from Medicare over MACRA. Given the predicted shortage of doctors over the next decade and an aging population, this would be disastrous.MACRA’s goal — to create a payment system that promotes better quality of care for patients and spends taxpayer money wisely — is sound. However, the necessary infrastructure to achieve that goal — meaningful quality measures and viable APMs — is not yet in place.If MACRA is implemented according to the arbitrary timeline set by the administration, it could force doctors to abandon private practice for salaried positions or leave practice altogether — neither of which would be good for patient care. So, yes, we all should care how doctors get paid.Right.is Submitted by John O’Shea via Liezette.com
May the Strength of God guide us.
May the Power of God preserve us.
May the Wisdom of God instruct us.
May the Hand of God protect us.
May the Way of God direct us.
May the Shield of God defend us.
May the Angels of God guard us.
– Against the snares of the evil one.
May Christ be with us!
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Christ be over all!
May Thy Grace, Lord,
Always be ours,
This day, O Lord, and forevermore.
This is a link to the live recent Senate Intelligence hearing regarding “Russian Hacking and Cybersecurity.” This is a murky link. This is a link to The Sea Trials of an Unfortunate Sailor, my book about the harsh realities of life in the navy during the Don’t Ask Don’t Tell era. What is the relevance […]
I read this generally well-written blog about the lies which are spread about our southern neighbor. There is much here to contemplate.
Briefly the Lies are:
- Mexico has a wall on its southern border.
- Mexico does nothing to fight the drug cartels
- Mexico does nothing to stop illegal migrants from crossing into the USA
- Mexico sends millions of illegal migrants into the USA
- Mexico has tougher immigration laws than the USA
So let’s take them one at a time.
- Mexico does not have a wall on its southern border. Follow-up question. Is this good or bad for either Mexico or the USA? The border is notoriously porous and merely amounts to some extra income for the border guards as they get a few pesos to look the other way. Since a large number of illegals (especially the tsunami of unaccompanied minors two years ago) were not Mexican, this porous southern border merely exacerbates the Mexican-USA problem. The USA has become the single greatest target for illegal aliens in the western hemisphere.
Conclusion: Absolutely false, unfortunately.
2) The question has actually never been whether Mexico did nothing but rather whether Mexico did ENOUGH. The level of corruption in even the higher levels of police in Mexico means that money spent or given to Mexico by the USA to fight drug cartels is more than likely used to line the pockets of police (as a best case scenario) or used to corrupt the officers to look the other way (worst case). Fast and Furious is a good example of the unforeseen consequences of throwing dollars at problems
CONCLUSION: Not the right question. Whatever they do, corruption makes the situation worse.
3) Same problem. Nothing is a very low threshold. Does Mexico do ENOUGH to seal its border with the USA. It is obvious from recent events that this is not so. A case before the SCOTUS involves the very sad case of a USA border guard killing a child who was with a group of other adolescents who were taunting him by running back and forth across the border. If Mexico is incapable of sealing off the border from the nefarious schemes of children, how well does it do it for the coyotes and those who make millions a year from the illegal and unethical trafficking in humans?
Conclusion: Not the right question. If Mexico does not actively and successfully seal its border it can hardly complain if someone else does so.
4) False. Mexico does not send illegals to USA. That admission would be absurd for anyone seeking political office in Mexico. However, Mexico does accommodate illegal aliens and uses the money sent back as a substitute for any sort of social safety net.
Conclusion: False but beside the point. It has left the door open and turned out the light. Anyone wanting to better their families knows to go north.
5) False. Mexico has apparently gutted their immigration rules, and like the porous southern border, has made the Mexico-USA problem immeasurably worse. In consequence, Mexico is now between a rock and a hard place. If the USA seals its border, Mexico is now on the hook. Mexico is the most wealthy state in Latin hemisphere. Where will all the illegal aliens go if the door to the USA is barred?
Conclusion: False, unfortunately.
Without the porous USA border, vast amounts of dishonest cash would no longer be available to corrupt the workings of our fellow democracy to the south. A border closing is going to provoke hardships. Of that, there is no doubt. At the end of it, Mexico could be transformed into a model of a modern state. They already have one aspect of it, voter ID cards, which our own unenlightened country refuses to institute.
Near the end of the Mexican War, Generalissimo Santa Ana is quoted to have said, “Pity poor Mexico, so far from God and so near the United States.”
Perhaps, a little more distance between the USA and Mexico would serve both well.