90% Quality Tie-in

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This just in from our friends at the AAFP:

The Centers for Medicare and Medicaid Services (CMS) recently released the 2016 iteration of an annual report that outlines its quality strategy for the U.S. health care delivery system for the coming year. The agency’s 2016 strategy aims to achieve better overall health care by making that care more person-centered, reliable, accessible, and safe; keep people and communities healthier by supporting proven interventions that address behavioral, social, and environmental determinants of health; and spur smarter spending of health care dollars that ultimately will reduce the cost of health care for everyone. In January 2015, the administration set a pair of overarching goals for moving toward value-based payment within the Medicare fee-for-service system, and invited private sector payers to match or exceed those goals. The first goal is to tie 30% of Medicare payments to quality or value through alternative payment models by the end of 2016, and 50% by the end of 2018. The second goal calls for 85% of all Medicare fee-for-service payments to be tied to quality or value by the end of 2016, and 90% by the end of 2018.

Yes, you read that right.

  1. The first goal is to tie 30% of Medicare payments to quality or value through alternative payment models by the end of 2016, and 50% by the end of 2018.
  2. The second goal calls for 85% of all Medicare fee-for-service payments to be tied to quality or value by the end of 2016, and 90% by the end of 2018.

Quality and value. Two of the most unproven and ambiguous terms ever created are going to 90% in charge of how a physician is paid.  Be afraid.  Be very afraid.  And I am sure the idiots at the AAFP are patting themselves on the back over 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] 

  16 comments for “90% Quality Tie-in

  1. lin willett
    February 4, 2016 at 5:33 pm

    I respect my doctor, I appreciate the time and expertise he shares with me. I am embarrassed to be a Medicare patient, the burden & loss of revenue I bring hurts us both.

  2. Ellen Gooding
    February 4, 2016 at 10:25 am

    As a 68 y.o woman hoping to retire from teaching in a year or two, this is very frightening news. It increases my desire to move to a country with a reliable single payer health system. I’ve already been told that the only doctor in my current family practice who will accept medicare will be the PA. The promises of years of paying into government systems is being ravaged by greedy corporations at the expense of a population which can only expect increasing poor health care. I’m angry – and scared.

    • Pat
      February 4, 2016 at 11:42 pm

      Corporations ??

  3. Kurt
    February 3, 2016 at 4:58 pm

    I pass the next ABFM test I am quitting the AAFP as I don’t need their magazine anymore as I will be retiring after a few more years. Be sure to tell med students to avoid primary care as they will be spending their purgatory on earth. Best to be assigned there after death at least.

    The only happy FP is the one who is retired or able to retire soon.

    Not worth going to DPC if < 5 years to go.

  4. JRDO
    February 3, 2016 at 4:17 pm

    “Making more with less” seems to be the current mantra for business nowadays. Here in Michigan the Ford Motor Company and General Motors have just reported records profits- mostly based on the cost/staff cutting which occurred during the great recession in 2007. Apparently Medicare has learned much from the success of this business model. Instead of dealing individually with thousands of individual physicians in MI there are now 15 ACOs that Medicare interacts with (http://www.crainsdetroit.com/article/20150208/NEWS/302089981/many-michigan-acos-saving-millions-under-medicares-cost-saving-plan). By shifting the monitoring and payment mechanisms to the ACOs from Medicare itself, the government is following big business’ playbook of outsourcing and doing less. As everyone who reads this blog is seemingly aware of- this is a business decision, it has nothing to do with improving the care for patients. Last year my ACO gave me a 6 figure bonus, this year I (and the other physician in my ACO) received no bonus although my care of patients hasn’t changed. It’s maddeningly difficult to plan for the future when large revenue swings occur seemingly arbitrarily. Although I much prefer being in private practice (I hated being an employed physician), I don’t trust the administrators of my ACO any more than I trust the administrators of health insurance companies or the government administrators. I’m getting more and more interested in DPC……

  5. RSW
    February 3, 2016 at 3:29 pm

    AAFP Board President Benedict Arnold, M.D. collects photo-op reward for stabbing family physicians in the back:

    http://www.aafp.org/news/government-medicine/20160104advocacyear.html

    • Kurt
      February 3, 2016 at 5:02 pm

      Oh, BTW.
      How much does that guy get for leading lambs to slaughter?
      I believe every member should quit the organization so they have to fold up.

  6. RSW
    February 3, 2016 at 12:51 pm

    The full horror of how the AAFP has gone to war against family physicians starts to become clear:

    http://blogs.aafp.org/cfr/inthetrenches/

    • Perry
      February 3, 2016 at 2:55 pm

      Yep, the docs in the trenches are being now covered with dirt by bulldozers.
      See Ya!

    • Pat
      February 3, 2016 at 3:19 pm

      Wow, ‘horror’ might be too soft a word. Now docs who barely grasped their cash flow will have no chance at it now that the gov’t can penalize them on a two-year “look back.” And “quality values” are assigned indirectly proportional to “resource utilization values.” No one with a brain, or desire to be happy in honest work should enter this rotten industry. The MIPS promises a full 15% bonus to docs working in a certified pt-centered medical home. Those practitioners are contemptible.

      • RSW
        February 3, 2016 at 3:33 pm

        Perhaps the most despicable thing about this AAFP-endorsed plan is that, every year, the bottom 25% of family physicians will get the full penalty – it’s impossible for everyone, no matter how hard they work, to pass the test.

  7. Steve O'
    February 3, 2016 at 9:22 am

    The agency’s 2016 strategy aims to achieve better overall health care by making that care more person-centered, reliable, accessible, and safe; keep people and communities healthier by supporting proven interventions that address behavioral, social, and environmental determinants of health; and spur smarter spending of health care dollars that ultimately will reduce the cost of health care for everyone.
    I have buzzword Bingo! sir. What’s my prize?
    (PS: Our IOM chums have tightened and redefined ‘diagnosis’ to a relevance-free concept. They make diagnosis almost impossible to accomplish according to definition. The next edition of Medical Word Salad will, no doubt, include improvement in the shameful epidemic of diagnostic errors in American healthcare.)

    • Perry
      February 3, 2016 at 11:41 am

      I like the word “estimation”. In my estimation you have a severe case of heartburn. Could be a major heart attack, so if you don’t live until tomorrow, I’ll change my estimation of your condition.

  8. Perry
    February 3, 2016 at 8:55 am

    The death knell for small independent practices, thanks AAFP. It’s bad enough now not knowing how you will be reimbursed year after year with rising costs of running a practice, now it will be even harder based on these convoluted formulas. Costs of EHRs will continue to be burdensome.
    Say hello to mega-industrial medicine practiced by poor flunkies in large hospital conglomerates.
    I agree Dr. Gaustavino, the Titanic has hit the iceberg and is going down bigtime.

    • Steve O'
      February 3, 2016 at 9:24 am

      To paraphrase the surgeons – every sinking ship eventually stops.

  9. Dr Thomas D Guastavino
    February 3, 2016 at 6:40 am

    Once again, DPC for primary care and for specialists, super specialization and avoidance of high risk, complicated, demanding or uncooperative patients. Get your lifeboat prepared and ready to go.

Comments are closed.