How Your Doctor Will Get Paid--Should You Care?

Annette FMeeska Mooska Mouseketeer…

…Mouse Cartoon Time Now is Here.

The Original Mickey Mouse Club

Yes, I had a crush on Annette. What baby boomer guy didn’t? That Meeska-Mooska chant was burned into my brain at an early age. And singing our adaptation of the Mickey Mouse Closing Theme (now it’s time, to say good night) at baby bedtime has been a family tradition for a couple of generations. So it’s no surprise that I felt like putting on my Mickey Mouse ears and going back to a simpler time after attending a dinner meeting of my medical group Tuesday night. The main topic on the agenda, right alongside the filet and tiramisu, was Medicare’s new payment plan, the “Medicare Access and CHIP Reauthorization Act of 2015”, affectionately known as MACRA.

What is MACRA?  It describes the new system that will slowly change the way physicians and other health care providers are paid for services to Medicare patients. In simpler days, your doctor examined you, operated on you,  followed you in the hospital. A bill was sent and either you, or your insurance company, or Medicare, paid it. Do a service, send a bill, get paid. Pretty straight forward, right? But over the past decade Medicare has inserted one word into the formula. Do a service WELL, send a bill, get paid.

I have no quibble with that change in philosophy. However, the difficulties include:

  1. Who defines “well”.
  2. What criteria do they use?
  3. How do you measure what “they” define?
  4. How do finances fit in?
  5. What impact does  the above have on the relationship between doctor and patient?

There are no easy answers to any of the above questions, and the process has been evolving. Results have included “expert” panels that really weren’t so expert making medical care recommendations (more on that in a future blog), the almost universal presence of Electronic Health Records replacing paper medical files (great in concept, very clunky in execution, great at allowing regulators easier access to data), and the growth of medical systems such as the Chicagoland behemoths Advocate Health Care and Northshore University Health Systems. It has also lead to a series of ever changing programs  that help define how Medicare pays your doctor. We have struggled through an alphabet soup of SGR, PQRS, MU, ACO, and now MACRA, with its evil step-children, MIPS and APMs (don’t ask).

What parts of this matter to you?  Should you care if your favorite doc earns a little bit more or less income every month? Probably not. Should you care if all this leads to better health for you and a smaller health care bill for the nation? Yes and yes. But if all this leads to your doctor typing into your medical record rather than talking to you, you should care about that too. And if smaller physician’s groups are driven out of business by the need to keep up with the changing rules, or if they all sell out to the “big boy” hospital systems you should definitely care about that, as it can impact your access to care.

There are no easy answers, and no crystal balls telling us how this will work out. I hope for the best from both sides of the equation, as my practice winds down and as Barb and I age and become  bigger consumers of health care.

There is only one thing I can say for sure…in American medicine, every day has become “Anything Can Happen Day!”

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