...Currently, the majority of traditional Medicare payments are based on the traditional fee-for-service model, where doctors are paid for every surgery, physical exam and CT scan they perform, regardless of patients’ outcomes. But alternative payment methods are gaining traction in the health community based on the quality of care, doctors’ performances, patient outcomes, readmission rates and patient experience to determine how much providers should be paid.
...Doctors, of course, want to know how one decides “the quality of care” short of negligence, and who will make those decisions. The greatest fear some patients have is that big city doctors – especially top surgeons and specialists – will drop out of Medicare altogether, which has already started to happen....
Two top doctors from the City University of NY School of Public Health who support Medicare reform – David U. Himmelstein and Steffie Woolhandler – wrote a blistering essay against Affordable Care Organizations in The Journal of General Internal Medicine in early January. In it, they accuse ACOs of being a new version of the reviled HMOs of the 70s and 80s: Their assessment was
Physicians were pressured to withhold care, and to hide that pressure from patients; bonuses of up to $150,000 annually were offered to doctors who minimized specialty referrals, inpatient care, etc. Our protest of those incentives, and a contract provision forbidding their disclosure (a 55 “gag clause”) led to “delisting.” Award-winning physicians—who often attract unprofitably sick 57 patients—were also delisted. An academic leader admonished physicians: “[We can] no longer tolerate having complex and expensive-to-treat patients encouraged to transfer to our group.” In the end, Americans concluded that fee-for-NON-service was even worse than fee-for service....“Make no mistake: the results to date on the performance of APMs (alternative payment methods) do not support the administration’s enthusiasm,” John O’ Shea, visiting fellow at the Center for Health Policy Studies at the Heritage Foundation, wrote in a blog post.
“Granted, fee-for-service may have its flaws, but before blindly pushing Medicare doctors and other medical professionals out of fee-for-service and over the cliff, the Obama administration should be sure they have a safe place to land.”
