In the movie “Heartbreak Ridge”, Clint Eastwood plays a grizzled Marine gunnery sergeant whose maxim is “Improvise, adapt, and overcome!” After his superior horribly bungles an alert drill, the commanding general bypasses the incompetent officer and asks the sergeant for his assessment. The incomparable answer: “Cluster-goat, sir!” Only he didn’t say goat.
The latest Family Practice News has a little back page article (silly migraine and fatty liver stuff on the front page), “In post-SGT era, physicians face two payment options.” The American College of Physicians mouthpiece stated, “There’s going to be a fork in the road…Physicians will have to choose one of two paths, you can’t do both.” But no, on selection the physician is not locked into either model and may change year to year. So you can revisit, and be turned by the same fork again and again until done?
- Option 1: Merit-based incentive payment system (MIPS). This is similar to current Medicare fee-for-service, except the physician will have to meet performance metrics or take a penalty. Yay, meaningful use. Docs in the MIPS are compared to their peers, and will be eligible for additional incentive pay if they are in the top 25th percentile. Which is the state paying its agents to fight each other, the moral equivalent of the gladiator industry.
- Option 2: Alternative-payment model (APM). This is a higher risk/reward route, wherein the doctor gets a guaranteed 5% increase yearly for 6 years, BUT “within the construct of an ACO.” Docs who don’t make the ACO cut will not be “rewarded with their shared savings.”
The incoming president of the ACP, Dr. Nitin Damle, has secured his lapdog status by promising “significant improvement in the quality of care and improved reimbursement.”
There will be no improvisation, adaptation, or overcoming. It’s all cluster-goat.