Stakeholders from across the healthcare continuum are raising red flags about provisions of Medicare's proposed physician fee schedule for 2015, including quality incentives and reporting for physicians, a new reimbursement code for chronic-disease management and a fact-finding initiative addressing concerns that Medicare is overcharged after hospitals acquire physician practices.
More than 2,000 comments were received on the 600-plus-page proposed rule. A final version is expected to be released by Nov. 1.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare spending, challenged the agency's approach of adjusting payments to clinicians based on the quality of care furnished to beneficiaries instead of the cost of that care.
“It may in fact be impossible for the Medicare program to transparently and reliably establish, collect, benchmark, assess and adjust payments based on quality measures for individual clinicians,” MedPAC said.
MedPAC's comment letter also suggested that the CMS' approach to this new system could lead to mass confusion because physicians are unlikely to understand why their Medicare payments are changing and what they need to do to improve their performance and increase their quality-based payments.
“A more promising avenue would be to encourage clinicians to organize into or join groups that take clinical and financial accountability for their patients, and have their performance assessed on the basis of a few key outcome measures,” MedPAC said.
Physicians also had mixed views on evaluating providers on an individual level for Medicare's Physician Compare website. The American Academy of Family Physicians warned that patients are overwhelmed by the volume of online information about quality measures that they don't understand, making it difficult for them to make informed decisions about where to seek care.
“We encourage the agency to avoid that outcome by including only the most important information about the physician as well as including educational products targeted at patients visiting the website,” AAFP said.
The AAFP also suggested that the CMS give group practices 90 days rather than 30 days to preview data about them before it's posted so they have enough time to review and validate the information and challenge the anything they think is wrong.
Insurers, meanwhile, warned that the CMS is creating a new opportunity for fraudsters by compensating physicians for the time they spend outside of face-to-face visits managing care for patients with two or more chronic conditions.
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