VIRGIL DICKSON | APRIL 23, 2018
The CMS is planning to launch a new pay model that would allow Medicare beneficiaries to contract directly with physicians.
Under current law, physicians are paid under a fee schedule in Medicare that includes limits on the amount they can bill beneficiaries per service unless they choose to opt out of Medicare and privately contract with all of their Medicare patients.
Private contracting would allow physicians to bill seniors for charges that are more than the rates approved by Medicare. These sorts of arrangements are known as balance-billing, a controversial concept that was backed by former HHS Secretary Dr. Tom Price.
In its announcement Monday, the CMS said that a direct provider contract model would allow providers to take further accountability for the cost and quality of a designated population to drive better beneficiary outcomes.
“Such a model would have the potential to enhance the doctor-patient relationship by eliminating administrative burden for clinicians and providing increased flexibility to provide the high-quality care that is most appropriate for their patients, thus improving quality while reducing expenditures,” the CMS said in an announcement.
The CMS said it plans to launch the model in response to comments received late last year to an RFI on what new priorities the CMS Innovation Center should pursue. The agency received 1,000 comments, which were all posted on Monday.
Ascension, the nation’s largest not-for-profit health system, supported private contracting in its comments to the agency. Officials for the Catholic system said this approach would make funds available to beneficiaries upfront and allow them to directly contract for primary care and related services through a subscription payment.
The upfront funding could also be used to pay for services that are not presently covered under Medicare.
“This aspect of such a model would allow both a beneficiary and provider, in partnership to define what has value and create competition for such services,” the Rev. Dennis Holtschneider, chief operations officer at Ascension, said in a comment letter.
The American Association of Neurological Surgeons also praised the suggestion and said it could lead to greater access to seniors that face barriers to coverage.
But consumer advocates slammed the proposal. The AARP said private contracting opens the door for doctors to pick and choose the patients or services for which they will bill Medicare.
“(Current) rules prevent doctors from choosing patients based on the severity of their illness or other characteristics or charging different patients different amounts,” the group said. “These rules also reduce the likelihood of fraudulent billing, help maintain access to care for Medicare beneficiaries, and protect patients from high out-of-pocket costs.”
Before the CMS launches the new model, it is seeking additional comments through May 25 on the structure of the program.
Source: Modern Healthcare