Q. I hear that Medicare is proposing a new payment arrangement for doctors that may dramatically impact access to care by seniors and other beneficiaries. Do you know anything about that?
A. You heard correctly. Medicare is proposing a new flat rate reimbursement system for doctors who treat Medicare patients. Some worry that the plan may reduce payments to specialists and cause fewer doctors to accept Medicare patients.
The Centers for Medicare and Medicaid Services (“CMS”) claims that the proposed changes are designed to reduce paperwork by combining four levels of forms required for reimbursement into one form and one fee paid to doctors. However, under the new system, doctors who see generally healthy patients and doctors who see more complicated patients would receive the same flat fee. According to a report by National Public Radio (“NPR”)”, the flat fee would mean doctors who specialize in complex medical areas would receive a smaller reimbursement than under the current system. Doctors would receive the same amount regardless of whether they spent 15 minutes with a patient complaining of a head cold or an hour with a patient with stage 4 cancer.
As NPR reports, doctors are worried the new payment system will cause more specialists to refuse to see Medicare patients. In addition, doctors who do see Medicare patients may spend less time with them. And the implications extend beyond Medicare because private insurers often follow Medicare’s lead.
Due to the possible implications of the flat fee, advocates are asking CMS to start with a demonstration project rather than changing the entire reimbursement system for all physicians at once.
CMS is accepting public comments until September 10, 2018. The new fee structure would go into effect in January 2019.
References: To learn more about the proposed changes go to to the NPR article, and the New York Times article of July 22, 2018. For those who wish to go directly to the source, here is the link to the CMS proposed rule change.