CMS terminates bonus policy aimed at dealing pay disparity between doctors

Most primary care practitioners will be a less poor next year due to the expiration of a health law policy that has been paying them a 10% bonus for caring for Medicare sufferers.

Some state the loss may trickle down to the sufferers, who could have a difficult time seeking a doctor or have to wait a lot for appointments. But others claim the policy has had little influence on their practices, if they knew about it at all.

The incentive program imitated in the year of 2011 and was establish to deal disparities in Medicare compensations between primary care physicians and experts. It distributed $664 million in bonuses in the year of 2012, the latest year that figures are present, to roughly 170,000 primary care practitioners, granting each and every one an average of $3,938, in accordance to a year 2014 report by the Medicare Payment Advisory Commission.

However that may sound like a minor adjustment, it can be significant to a primary care practice, states Dr. Wanda Filer, president of the American Academy of Family Physicians. “It is not so much about the salary as it is about the practice expenditure,” she elaborates. “Family medicine flows on very huge margins, and sometimes on negative margins if they are paying for EHRs, for instance. Every few thousand makes a distinction.”

Doctors who are expert and specialize in family medicine, internal medicine and geriatrics are qualified for the bonuses, as are physician assistants and nurse practitioners.

Medicare normally pays lower fees for primary care make a tour to evaluate and coordinate sufferers’ care than for procedures that experts perform. The mere distinction is depicted in physician salaries. Half of the primary care physicians made less than $241,000 in the year 2014, while for experts the halfway mark was about $412,000, in accordance to the Medical Group Management Association’s yearly contributor compensation survey.

The influence of the bonus policy is greater on practices with a substantial number of Medicare sufferers. Dr. Andy Lazris estimates 90% of the sufferers that his 5-practitioner practice in Columbia, Md., treats are on Medicare.

“When the bonus payments began, it was a quite huge deal for us,” Lazris states. The extra $85,000 they received yearly permitted them to hire 2 persons to address with the administrative needs for being part of an accountable care organization and to assist the practice incorporate 2 new Medicare policies regarded to managing sufferers’ chronic ailments or overseeing their shifts from a medical service to home.

Next year, if they cannot make up the lost bonus finance by giving more facilities, it will mean a pay cut of $17,000 each practitioner, Lazris claims.

However in some practices, doctors try to analyze more sufferers to make up for cuts in compensations that are tougher for a group concentrating on the elderly. “Part of what we do in geriatrics is spending a lot of time with our sufferers,” he claims. “We have to, when someone has 5 conditions and takes 5 minutes to get into the room. The primary office visit is thirty minutes.”

The incentive policy was an effort to deal shortcomings in Medicare’s network of paying contributors mostly a la carte for facilities, which tends to undervalue primary care contributors’ ongoing character in coordinating sufferers’ care.  Initially this year, Medpac integrated that Congress replace the expiring primary care incentive policy with a per-beneficiary payment to primary care quacks/physicians that would be paid for by lessening payments for non-primary care facilities. That proposal has not made any headway. During time, physician trade teams have lobbied unsuccessfully for an extension of the Medicare bonus policy.

The expiration of the Medicare incentive policy is specifically painful because it comes on the heels of a same bonus policy for Medicaid primary care facilities that ended in the year 2014, states Dr. Wayne J. Riley, president of the American College of Physicians, a professional organization for internists.

“There will be few physicians who claim they cannot take any more Medicare sufferers,” Riley predicts.

An attorney for an advocacy team for Medicare beneficiaries says they motivate the bonus payments and expert physicians will not shut them out.

“We do not have any proof to indicate that primary care docs will prevent analyzing Medicare beneficiaries without the payment bump,” states David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy.

The huge majority of non-pediatrician primary care doctors accept sufferers who are covered by Medicare, in accordance to a national survey of primary care contributors by the Commonwealth Fund and the Kaiser Family Foundation. But while 93% take Medicare, a minor percentage, 72%, admit new Medicare sufferers.

Not entire primary care practitioners will miss the incentive policy, in accordance to the Commonwealth/KFF survey. Only 25% of those surveyed claimed they acquired a bonus payment; half did not know the program existed.

Of physicians who were knew that and acquired Medicare bonus payments, 37% claimed it made a minor difference in their capability to serve their Medicare sufferers, and 5% claimed it made a huge difference. Although, approximately half – 48% — claimed it made no difference at all.