Multiple primary care Physicians will have to be a little poorer next year after the health law program ends, paying them a 10 percent bonus for caring for Medicare patients. Some people say the damage can upset patients, who may have a difficult time finding a doctor or may have to wait longer for appointments. But others say the program would have had little effect on their practices if they had known about it.
The incentive program began in 2011 and was designed to address disparities in Treatment Reimbursement between primary care physicians and specialists. It disbursed $ 664 million in bonuses in 2012, the most recent year figures available to approximately 170,000 primary care physicians, each averaging $ 3,938, according to a 2014 report By the Medical Payment Advisory Commission.
While this may sound like a small adjustment, it may be important for a primary care practice, Drs. Says Wanda Filer, president of the American Academy of Family Physicians. “It’s not so much about salary as it is about practice expense,” she explains. “Family medicine operates on a very small margin, and sometimes on a negative margin if they are paying for electronic health records, for example. Every few thousand makes a difference.”
Doctors who specialize in Family Medicine, Internal Medicine and Geriatrics Eligible for bonus, As are nurse practitioners and physician assistants.
Medicare typically pays a lower fee for primary care visits to evaluate and coordinate patients’ care than procedures performed by specialists. The difference is reflected in the physician’s salary. According to the Medical Group Management Association, half of primary care physicians were under $ 241,000 in 2014, while the halfway mark for specialists was $ 412,000. Annual provider compensation survey.
“When the bonus payment started, it was a very big thing for us,” Larris said. The additional $ 85,000 he received annually allowed him to appoint two people to deal with administrative requirements to be part of an accountable care organization and two new Medicare programs related to the management of patients’ chronic illnesses in the practice. Involve or help with medical care of your home.
Next year, if they can’t make up for lost bonus money by providing more services, that would mean a $ 17,000 salary deduction per physician, Lazris says.
However in some practices, doctors try to see more patients for reimbursement cuts, which is harder for a group focusing on the elderly. “Part of what we do in geriatrics is spend a lot of time with our patients,” he says. “We have, when one has five conditions and it takes five minutes to get into the room. The original office visit is 30 minutes.”
The incentive program was an attempt to address deficiencies in Medicare’s payment system, a la carte for most services, which follow the ongoing role of primary care providers in coordinating the care of patients. Earlier this year, MedPAC proposed that Congress replace the primary care incentive program ending with per-beneficiary payments for primary care physicians, which would be paid by reducing payments for non-primary care services . That offer Has not made any headway. Meanwhile, physician trade groups have unsuccessfully lobbied for the expansion of the Medicare bonus program.
Medical incentive program is ending Especially painful Because it comes on the heels of a similar bonus program for Medicaid primary care services, which ended in 2014, Drs. Wayne J. Riley, president of the American College of Physicians, calls it a professional organization for internists.
“There will be some physicians who say they cannot take any more Medicare patients,” Riley predicts.
An advocate for an advocacy group for Medicare beneficiaries says they support bonus payments and hopes that physicians won’t turn them down.
“We have no evidence to show that primary care docs will stop looking at Medicare beneficiaries without paying payments,” says David Lipsitz, a senior policy attorney at the Center for Medicare Advocacy.
Non-pediatricians accept the vast majority of primary care doctors to patients who are covered by Medicare, according to A. National Survey of Primary Care Providers By the Commonwealth Fund and the Kaiser Family Foundation. But while 93 percent take Medicare, a small percentage, 72 percent, accept new Medicare patients. [Kaiser Health News is an editorially independent program of the Foundation.]
Not all primary care physicians Miss the incentive programAccording to the Commonwealth / KFF survey. Only 25 percent of those polled said they received bonus payments; Half the program did not exist.
Of physicians who knew and received Medicare bonus payments, 37 percent said it made a small difference in their ability to serve Medicare patients, and 5 percent said it made a big difference. However, nearly half – 48 percent – said it did not matter.
Wrote this article for michelle andrews Kaiser Health News (KHN), a non-profit national health policy news service. It has been reprinted with permission.