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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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] 

  3 comments for “Medicare Fun

  1. April 14, 2019 at 8:26 pm

    Hoping the day never arrives that we can only give our clients MAPD’s. (Dislike them. A lot). We provided our clients with Medigap 99.9% of the time. When people understand what they’re buying; they don’t want MA plans. But, as you point out, the govt push is getting stronger and stronger….

  2. Steve O'
    April 14, 2019 at 11:52 am

    ACO’s appear to be Frankenstein HMO’s of 30 years ago, but deliberately fragmented so that they can’t be well-organized. Insurance companies don’t want them as competitors.
    Rather, they can be middlemen who absorb all the financial risk.
    Insurers don’t want risk. That’s all the insurance biz is about. No risk, plenty of profit. Voters don’t want risk. That costs them fees for services. Let someone else underwrite the risk.
    Some stooge will be stuck with all the risk, preferably some dummy without an MBA.
    The problem is, stooges get smart or go broke. That takes a couple of years, and the can gets kicked down the road aways.
    The plan isn’t to make something that might work. The problem is to get another couple of years.

  3. James Tinsley
    April 14, 2019 at 11:15 am

    Thanks. Used this in a FB add.

Comments are closed.