Changes are coming, are you ready?

The “Physician Value-Based payment modifier” will start in 2015.  Payment will be based on 2013 data. This program will become a reality for Physicians in January of 2013.  Wait we know what you are thinking! This is part of Affordable Care Act and that may not pass! Well hold on to your hats – this is CMS speaking and they are using the peoples’ money to pay physicians.   In CMS terms it is a “game changer”, designed for “making physicians accountable for costs”; this was spoken recently by Anders Gilberg, Senior Vice President at the Medical Group Management Association.  In theory, and they hope in Practice, CMS will shift payments from high cost providers to lower cost providers.

The Center for Studying Health System Change, indicates that the formula CMS (Medicare) ultimately designs will be used by private insurers to reimburse physicians/Clinicians.  So you say this can’t happen! Well it can happen and ultimately, it will.  Each physician who receives Medicare Payment is providing CMS with the data it needs.  Yes it is true that it is difficult to make judgments about costs associated with small groups or individual practices but there are data.  Data from 2013 will be the basis for Changes in Payments to Physicians starting in 2015.  It is our sense that something will be done about the payment system because CMS is bleeding money and a large percentage of the population will be using Medicare as their primary insurer.  As of now Medicare is the country’s largest insurer.  So why do you think it can’t happen?  The Associations will fight back but it is inevitable that the current reimbursement system will change even if the Affordable Care Act doesn’t.

Does this mean every practicing physician in solo or small groups should join a large group or become affiliated with Accountable Care Organizations?  This is not practical at the moment but having a better understanding of what the CMS data say about your practice might be a good place to start.