Will Health Quality Improve Under New Medicare?

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 Congress repealed the SGR in 2015 and replaced it with the MACRA Quality Payment Program.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.


  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

Connect with TMA on Twitter, Facebook, and Instagram.

Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.

Last Updated On

June 28, 2023

Originally Published On

October 24, 2016

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