New Payment Model for Docs

cms

Our government, via the CMS, has released a draft on how it would support a new payment model.  It is called the Quality Measure Development Plan and it is beautiful.   The new Merit-based Incentive Payment System (MIPS) is for providers who choose to participate in alternative payment models (APMs).  You got that?  MIPS and APMS.  Now these MIPS and APMs replaced the Medicare Access and CHIP Reauthorization Act of 2015 or what is called the MACRA.The MACRA effectively sunsets payment adjustments for three existing clinician reporting and incentive programs—Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM), and the Meaningful Use Electronic Health Record Incentive Program for eligible professionals.  You still with me?   Let me continue with exact wording from the plan:

The PQRS, VM, and EHR Incentive Program programs have each played an important role in the early development of physician-based quality measurement and reporting in the Medicare program but to reduce provider burden, CMS seeks to optimize efficiencies through greater alignment across these programs.

The draft Quality Measure Development Plan released on Friday by CMS focuses on gaps identified in the quality measure sets currently in use in PQRS, VM and Meaningful Use, offering recommendations for filling these gaps.

To fill identified measure and performance gap areas, CMS will expand and enhance existing measures to promote alignment and harmonization in the selection of measures and specifications, while concurrently developing new (de novo) measures.

According to CMS, starting in 2019 the agency will apply a positive, negative, or neutral payment adjustment to each MIPS eligible professional based on a composite performance score across four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology.

Is this crystal clear to you?

I have a new payment model that I think would work better.  It is actually an old model.  It is called CASH.  Opt out of this crap like I did and take CASH.  No more MIPS, APMs, MACRA, PQRS, VM, MU, EHRIP.  There is no proof this stuff works.  My only quality indicator is whether patients feel I am doing a good job for them. If I don’t then they leave and I don’t get any more of their CASH.  That model has worked for all civilizations since humans have been on this planet. I think I will continue it.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “New Payment Model for Docs

  1. Robin Miller, MD
    December 30, 2015 at 10:32 am

    I opted out of medicare and all insurance plans 10 years ago and have never been happier with my practice!

    • DrG
      December 30, 2015 at 1:23 pm

      You should be a role model for the rest.

  2. Steve O'
    December 28, 2015 at 11:06 am

    Don’t worry:
    According to CMS, starting in 2019 the agency will apply a positive, negative, or neutral payment adjustment to each MIPS eligible professional based on a composite performance score across four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology.
    Sooo….it COULD be a way to pay doctors more. Right?

    On a second note, shout out to the AMA and the various Boards for a terrific job at taking over the role of command – Physician Individual Merit Performance Scale. Thanks, sugardaddies! I’m a-shakin’ it!

  3. Pat
    December 28, 2015 at 9:05 am

    The Care Available Supportive Home, or CASH-model is evidence-based with centuries of data confirming its quality effectiveness, and efficient resource usage. Further empiric data has overwhelmingly shown that participation in Medicare, Medicaid, and a host of “private” plans degrade from the primary care physician the essential qualities of Competence, Affability, Sincerity, and Humor, so necessary for the CASH model.

    • Perry
      December 28, 2015 at 10:05 am

      Well said.

  4. Perry
    December 28, 2015 at 8:44 am

    I’d like a job working for CMS coming up with silly convoluted payment structures for physicians.

    • Steve O'
      December 28, 2015 at 11:00 am

      There’s no call.

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