Oct. 24, 2016
Your Medicare doctor visit
will likely change in the next year or so. Medicare is revolutionizing how
physicians are evaluated and paid to provide care, and patients will see
changes as a result, focusing in their care quality. As Texas doctors adapt to the
new Medicare payment system, many are concerned about the changes, while others
are optimistic the transition will result in healthier patients. The switch to
the new Quality Payment Program under the Medicare
Access and CHIP Reauthorization Act (MACRA) means physicians who care for Medicare patients
must change how they run their practice – and care for their patients.
“Patients should care, because
healthcare costs are rising and the quality of care varies,” said Keller family physician
Gregory Fuller, MD, chair of the Texas Medical Association (TMA) Council on
Health Care Quality. “We have to get away from fee-for-service,
reactive healthcare which hasn't improved quality and outcomes.”
Under the previous payment
system, a “fee-for-service” arrangement, doctors were paid for each test or patient
treatment. As TMA’s Texas
Medicine magazine reports,
that system is gone -- replaced by one that measures the quality of patients’ care and health outcomes. Doctors
will be required to show sustained quality, safety, and the leadership to
enhance care for their patients. The goal is to shift medical practice from
reactive treatment to preventive care and help patients live healthier lives. Doctors
also are hopeful the new system will reduce medical errors.
The Medicare pay-structure
change was long-awaited. For years, TMA and other healthcare advocates lobbied
Congress to repeal the old system, the flawed Sustainable Growth Rate (SGR)
formula.
The SGR Medicare payment system was enacted in 1997 to lower costs but ultimately
threatened physicians repeatedly with unsustainable pay cuts, causing turmoil
for doctors and patients. Congress repealed the SGR in 2015 and replaced it
with the MACRA Quality Payment Program. That program offers doctors two pathways
for Medicare payment which will go into effect over a time through 2021.
"Reimbursement models
are changing rapidly, and physicians will need to learn to proactively make the
changes necessary in a thoughtful and methodical way in order to be successful
in their individual practices, and most importantly, be successful in caring
for patients," says Prathibha Varkey, MD, American College of Medical
Quality president and chief executive officer of the Yale Northeast Medical
Group and senior vice president of Yale New Haven Health.
That change is threatens many
physicians, however. MACRA’s two doctor-pay
options come with new quality-reporting requirements. Doctors are forced to
invest in computer software to capture and report data, and training to comply
– by Jan. 1, 2017; too little time to prepare, in physicians’ minds.
TMA is helping doctors
adjust. In November, TMA will host the Texas
Quality Summit to inform physicians about the changes and help them accelerate
quality improvement in their small and large practices. It’s part of the tools for
doctors to learn about the new system. In July, TMA hosted a MACRA
Tele-Town Hall call/meeting to explain details about the new Medicare law.
Angst aside, some TMA
physician leaders are encouraged by the potential patient benefit that could
come from this Medicare revision. "Some of the changes include having
someone in the office call and follow up with patients to see how they're doing.
Especially with high-risk patients, that's significant." says Javier
Margo, MD, a member of TMA's Council on Health Care Quality.
“It's hard not to be excited
about some of these changes when you see the potential for what they can
do."
TMA is the largest state medical society in the nation,
representing more than 49,000 physician and medical student members. It is
located in Austin and has 110 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
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Contact: Brent Annear (512) 370-1381;
cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
Marcus
Cooper (512) 370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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