BLOG: Fighting Words
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By Shannon Muchmore | July 13, 2016
(Story updated at 5:50 p.m. ET)
CMS Acting Administrator Andy Slavitt told lawmakers Wednesday that the agency is considering delaying the start date for Medicare payment reform, which is set to go into effect Jan 1.
Testifying before the Senate Finance Committee, Slavitt said the CMS is concerned that some physicians, particularly at small practices, may not be ready for the changes under the Medicare Access and CHIP Reauthorization Act that replaced the much-maligned sustainable growth-rate formula.
Several medical groups, including the American Medical Association, the American Academy of Family Physicians and the Medical Group Management Association, have encouraged the CMS to delay MACRA.
In his opening testimony, Slavitt said the CMS is open to alternative measures that will achieve the agency's objectives, which include patient participation and reducing reporting burdens for practices.
Senators continued to show great concern for small and rural practices, which have said MACRA could force them to join hospitals or larger practices because of the paperwork and payment changes required.
Slavitt said the CMS is aware of these potential conflicts and also concerned. The CMS has received "significant feedback", Slavitt said. "Some of the things that are on the table, (that) we're considering include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them."
“The focus on small independent practices and their ability to continue practicing independently is a very important priority for us,” he said.
Dr. Wanda Filer, president of the American Academy of Family Physicians said her organization has requested a MACRA start date of no earlier than July of next year and would prefer January 2018.
A lot of AAFP members are small groups of providers that are still trying to understand the rule and what it means for them. There are a lot of questions as well as some confusion and anxiety, she said.
But she has been pleased with how the CMS and Slavitt have reached out to answer those questions and provide help.
“I think we're cautiously optimistic that there's going to be some flexibility going forward,” she said.
American Medical Association President Dr. Andrew Gurman said in a statement he was “heartened” by CMS considering options such as alternative start dates and shorter reporting periods.
“Successful implementation will require flexibility, and indications are that CMS intends to work toward the goal of giving physicians a fair shot in adjusting to this new policy framework,” he said.
Slavitt also said methods of gathering data other than provider reports could help doctors focus on patient care. Some information could be gathered from automatic data feeds.
Senators asked about methods from reimbursing chronic care patients and those seeking advanced care directives. Slavitt said the CMS is looking to expand methods for reimbursing providers at higher rates for chronic patients, as was recently implemented with Medicare Advantage.
He also suggested further encouraging alternative payment models such as bundling, medical homes and team-based and prevention models.
“We need to get out of the mode of paying physicians just to run tests and prescribe medicines,” he said.
HomeArchivesVideoCartoonsAboutSearchLogin July 12, 2016More
By Keith Jackson
Private practice medicine in the United States is rapidly going away. In the past few years, the percentage of doctors who own their own businesses has plummeted. The middle class, the supposed beneficiaries of Obamacare, can't afford their deductibles and are avoiding necessary treatments and tests because of costs, leading doctors to have to care for them at more advanced stages of disease. Doctors (and nurses), the highest trained and most knowledgeable providers of patient care, are mostly data input vehicles for the massive electronic medical records systems. And the amount of money that has been shoveled into the great abyss of the new government bureaucracy is enough to have bought all of us excellent private care, yet our care and our coverage for that care is worse.
Before Obamacare, the percentage of physicians owning their own businesses was around 70%. It is now hovering around 30%. The reason for the shift is not widely reported. As costs to run their businesses have been going up, reimbursements to doctors are going down, making the margin for being able to stay open smaller and smaller. Meanwhile, hospitals are doing comparatively better. Why? Because they can charge more for a service than doctors can charge. Hospitals can do this because they have traditionally taken care of the uninsured, and states have written into their books a differential in the reimbursement to make things "fair." This differential allows hospital corporations the ability to afford to buy doctors' practices.
This affects costs adversely. (Get ready for a lesson in medical billing "transparency")...Continue reading here.
July 7, 2016
For immediate release:
July 7, 2016
CHICAGO – The American Medical Association (AMA) today responded to the Administration's initial plan to remove hospital payment incentives that have promoted consolidation in the health care industry. The new proposal from the Centers for Medicare & Medicaid Services (CMS), which is part of the 2017 proposed hospital outpatient payment rule, aims to better align payment policies for physicians in independent practice with those owned by hospitals. The CMS proposal could help stem the tide of consolidation by large systems and help small practices maintain their independence.
CMS proposes to reduce the incentives for hospitals to purchase physician practices by paying the same Medicare rates after future hospital acquisitions, whether physician services are provided in freestanding independent practices or in off-campus, hospital-owned practices. Exceptions are provided for emergency department services.
"Providing similar payments for similar professional services located outside of a hospital campus, regardless of facility ownership, could lead to a more level economic playing field and help preserve independent practice," said AMA President Dr. Andrew W. Gurman. "The new policy is more equitable for patients, who, CMS notes, often pay more for the same service provided in an off-campus department of a hospital."
Small, independent physician practices are a vital component of our nation's health care system, providing many valuable services to patients and communities. Maintaining their viability is key to preserving physician leadership in patient-centered delivery system innovation.
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AMA Media & Editorial
Written by Akanksha Jayanthi (Twitter | Google+) | June 22, 2016
Andrew Gurman, MD, is an orthopedic hand surgeon from Hollidaysburg, Pa., and the newly inaugurated president of the American Medical Association. Mr. Gurman also doesn't use an EHR, according to MD Magazine.
Mr. Gurman, the first hand surgeon and second orthopedic surgeon to ever serve as AMA president, has a solo practice in Pennsylvania. He told MD Magazine that it's cheaper for him to forgo the financial incentives of the meaningful use program than to adopt an EHR.
"I don't have an EHR," Dr. Gurman told MD Magazine. "I just take the penalties."
MACRA's payment adjustments are scheduled to begin in January, but Dr. Gurman said he is optimistic that CMS will provide support to individual and small practice owners like himself.
And CMS has already made moves to do so. HHS announced this week it will award $100 million over the next five years to organizations that provide support and training to Medicare physicians in group practices with 15 or fewer clinicians to comply with MACRA.
According to September 2015 data from the ONC, solo practitioners reported the lowest rates of EHR adoption among office-based physicians, with 64 percent adopting the technology.
Insights into health care and entitlement reform.
Opinions expressed by Forbes Contributors are their own.
Yevgeniy Feyman, Contributor
What leads to high prices in health care? Some might blame insurers, while others might look at the pharmaceutical industry. The punchline of course, is that there isn’t any health care boogeyman. There’s no single industry to blame for high prices. Instead, it has to do with how particular companies or industries behave. Where competition is lacking, prices tend to increase. A recent court decision upholding a proposed hospital merger – between Advocate Healthcare and Northshore Health Partners in Chicago – underscores this particularly well. Moreover, it underscores the need for states to be proactive in making health care competitive, instead of relying solely on high-risk litigation by federal agencies.
Read full story here.
American Bar Association's Physicians Legal Issues Conference: Industry Responses to Integration led by AID Executive Director Marni Jameson Carey.
Abuse of tax exempt status is rampant across America and needs a fix. Our remaining 49 states should wise-up and get a fat refund.
Written by Ayla Ellison (Twitter | Google+) | May 16, 2016
The tax-exempt status of 30 hospitals in New Jersey are uncertain due to a flurry of tax appeals filed in the state.
In June 2015, a tax court judge ruled Morristown (N.J.) Medical Center should not be exempt from property taxes as it failed to satisfy the legal test that it operated as a nonprofit, charitable organization for several tax years.
Following the judge's ruling, numerous municipalities in New Jersey filed tax appeals against nonprofit hospitals. As of April 1, 30 municipalities had filed tax appeals, according to NJBIZ, which cited information from the New Jersey Hospital Association. Read more here.
New law makes it easier for employed doctors to regain independence. Though a small step in one state, Connecticut is once again leading by example.
Revised physician non-compete bill wins final passage
Rep. Matt Ritter
A proposal to limit non-compete clauses in physician contracts and expand the type of entities that could employ doctors – viewed by proponents as a way to protect or increase competition in health care delivery – won final passage from legislators Tuesday night.
The bill that passed the House 138 to 10 differed from the version that passed the Senate last week; the Senate passed the new version later Tuesday night. It now goes to Gov. Dannel P. Malloy.
The proposal grew out of work by the Senate’s top Democrat and Republican to address the changing health care landscape, including the trend toward doctors giving up owning their own practices to work for hospital systems or large group practices. Senate President Pro Tem Martin M. Looney, D-New Haven, and Senate Minority Leader Len Fasano, R-North Haven, have expressed concern that non-compete clauses could limit doctors’ ability to return to community practice after going to work for a hospital system, limiting patients’ access to their doctors.
Under the bill, non-compete clauses would be allowed, but could not restrict a doctor’s practice for more than one year or more than 15 miles from the primary practice site. The version that first passed the Senate would have banned non-compete clauses in cases of doctors leaving for private practice, but that provision was removed in the final version that passed both chambers Tuesday. The bill that passed the Senate also allowed for a wider distance restriction, 20 miles, but it was reduced to 15 in the final version.
Read more here.
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