Moving from Fee for Services

Editor’s note: It is critically important that we move the reimbursement system from fee for services to fee for care. A movement in that direction is bundled services, but it has to be more than that. Payment has to involve information about efficient process, quality, and outcomes. Otherwise in the words of Demming, “If you only focus on the ends, you may get it in ways you never intended.”

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Expert: U.S. is on path toward health care payment reform
More than a dozen health care payment reform efforts are under way around the U.S., according to Karen Davis, president of the Commonwealth Fund. She told a conference that the country is on a path away from fee-for-service and heading toward bundled payments that go beyond pay-for-performance models. Healthcare Finance News (3/12)

Is the Work Ethic of Physicians Changing

Editor’s note: As physicians retire and as younger physicians take their place they are seeking a work/life balance.

According to a recent report, the average hours worked by U.S. physicians dropped from 55 per week in 1996 to 51 in 2008, coinciding with a nationwide 25% decrease in physician fees between 1995 and 2006, after adjusting for inflation.

Source: “Trends in the Work Hours of Physicians in the United States,” Journal of the American Medical Association, Vol. 303 No. 8, February 24, 2010, http://jama.ama-assn.org/cgi/content/full/303/8/747?home

Physician Hours Declining

Editor’s note: It is likely a more complex root cause. It is more than simply payments. Values, cultural changes and other interests are likely to play a role.

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Physician work week hours drop, study says
The average number of hours worked by U.S. physicians dropped from 55 per week in 1996 to 51 in 2008, a report said. The reduction was linked to lower physician payments, which decreased 25% from 1995 to 2006, data showed. Bloomberg (2/23)

Fee for Service Needs to Change to Fee for Care

Lower Medicare Fees Do Not Increase Volume Of Patient Care
However, reimbursement rates were shown to affect the kind of services and tests provided.

The ‘Doc Fix’ and the AMA

Editor’s note: While the proposed HIRE Act postpones the Medicare reimbursement cut (of 21%) to physicians, the AMA is condemning the short-sighted nature of the proposal. Congress has continually applied a patchwork fix to the issue. They ulimately will need to decide to take one direction or another on this very thorny issue.

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AMA calls for permanent fix to Medicare fee cuts for doctors
The American Medical Association condemned what it called the Senate’s short-term fix to block the 21% cut in Medicare reimbursements for doctors. The group said the provision, which is included in the Senate jobs bill, is a short-sighted solution that “increases the size of the cut and cost of reform and makes it very difficult for physicians to care for seniors and military families.” The AMA instead endorsed a measure tied to the health reform legislation that offers a permanent solution to the payment formula. BusinessWeek/Bloomberg (2/10)

The ‘Doc Fix’ is in the HIRE Act

Extension of Expiring Health Care Provisions. 

 

The draft HIRE Act also extends health provisions, a number of which expired at the end of 2009.  These provisions include a seven-month extension of the sustainable growth rate update formula.  Without this fix, physicians participating in Medicare face a 21 percent reduction in payments.  The bill also extends the exceptions process for Medicare therapy caps and extends payment provisions for mental health providers, ambulance services, physicians in areas where the work geographic practice cost index (GPCI) is below 1.0, certain physician pathology services, the rural hospital flexibility (Flex) program, improved payments for outpatient services in hospitals in rural areas, direct billing for Indian health service providers, Medicare hospital wage index reclassifications under the section 508 program, provisions concerning long-term acute care hospital services, and certain Medicare Advantage plans, including special needs plans, cost plans and senior housing programs. The draft bill would also provide an accreditation exemption for certain pharmacies that furnish durable medical equipment and would clarify eligibility for physician health information technology incentive payments. And finally, the draft bill would keep the 2009 federal poverty guidelines to protect people in means-tested programs from losing benefits and includes a provision to disregard refundable tax credits and refunds as income for twelve months from receipt. The total cost of the health extenders provisions is about $10 billion over ten years.

The Patient of the Future

Looking past the current problems with the healthcare system, HealthLeaders Media looked to the future and a more engaged patient and physician. An obstacle is the current reimbursement model—as well as the patients and physicians themselves. Though technology can help bring the two sides together, it can’t do it alone. However, a new relationship might just be able to transform healthcare. Link to the September issue.

AMA Backs Health Reform

he nation’s largest physician lobby has officially endorsed the Senate’s health reform package—which cleared key hurdles over the weekend—after it won assurances from lawmakers that they would work to craft a long-term solution for Medicare payment come January 2010.

The original Senate bill included a measure that would erase a 21% pay cut in 2010 with a 0.5% increase, but an amendment, filed on Saturday, squashed the provision.

http://www.modernhealthcare.com/article/20091221/FREE/312219953