Medicare Fun

The Medicare Payment Advisory Commission is exploring options for moving further away from fee-for-service reimbursement that include allowing beneficiaries unrestricted choice of health care providers while incorporating bundled and site-neutral payments as well as new quality incentives. Here are the models:

  • Scenario 1: Traditional FFS continues and incorporates reforms such as bundled payments, site-neutral payments and new quality incentives. Beneficiaries continue to receive their choice of “any willing provider.”
  • Scenario 2: Traditional FFS option is removed. Providers must join ACOs to be eligible for FFS payments and Medicare assigns all FFS beneficiaries to ACOs. The Centers for Medicare and Medicaid Services (CMS) pays claims for ACOs using FFS rates. Beneficiaries retain the option to enroll in Medicare Advantage (MA) plans.
  • Scenario 3: Traditional FFS option is removed. MA plans and ACOs pay providers for all services, but CMS continues to release the FFS fee schedule. “ACOs effectively become capitated health plans,” according to MedPAC briefing documents.
  • Scenario 4: Total elimination of FFS program. CMS would not maintain the FFS fee schedule. MA plans and ACOs pay providers for all services.

My thoughts? Thank god for Direct Primary Care. I will never deal with this stuff. Ever.

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