Health and Science

Feds' new plan to wean some doctors off 'fee-for-service'

You — and 25 million other people — might be getting more time and attention from your doctor soon if you're part of this upcoming program.

The Obama administration on Monday said it will launch a new model for the way Medicare pays many primary care doctors for taking care of groups of patients next January, shifting away from a much-criticized "fee-for-service" system to one that encourages paying for actual patient health outcomes.

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The administration said the up to 20,000 primary care doctors expected to enroll in the program will receive monthly "care management fees" that will give them more freedom to deliver care that is appropriate to their patients, instead of having to rely exclusively on fees for each service they provide an individual patient.

Doctors who see better health outcomes for their groups of patients, as determined by a set of performance data metrics, will keep all or most of those fees, while physicians who fall short will have to repay some of those fees.

The new "Comprehensive Primary Care Plus" model is expected to affect how payments are made for up to 25 million patients who are cared for by 5,000 medical practitioners in 20 regions.

In addition to Medicare, some Medicaid payments and payments by private insurers are expected to be included in the model, according to the federal Centers for Medicare and Medicaid Services.

"The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care," CMS said in a statement announcing the new model, which will operate for at least five years.

The model will join several other CMS "alternative payment model" initiatives, that are part of a broad effort "to move our health care system toward one that rewards clinicians based on the quality, not quantity, of care they give patients," the agency noted. Last month, the Obama administration said that it had beat, by almost a year, its goal of tying 30 percent of Medicare payments to "quality and value through alternative payment models."

The administration is now trying to tie 50 percent of Medicare payments to alternative payment models by 2018.

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Dr. Patrick Conway, CMS deputy administrator and chief medical officer, said the new primary care payment model, which will start taking applications from medical practices July 15, "represents the future of health care that we're striving towards."

"It takes the patient off the assembly line, and puts them in the center of their care," Conway said.

He said that because of the way Medicare currently pays primary care doctors for treating patients, extra time a doctor spends talking with a patient or having their office follow-up with the patient to make sure they are complying with their prescribed treatment will not necessarily lead to a payment to the doctor under the fee-for-service system.

Conway noted that the fee-for-service system "costs us all" because it leads to "more tests and procedures" being ordered by doctors, who are paid for each procedure they perform, instead of being compensated for improving the overall health of the patient, and keeping them out of the hospital.

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Under the model, participating medical practices will opt for one of two "tracks."

In track one, "CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities," CMS said.

In track two, practices will also receive such a monthly care management fee, but instead of getting the full Medicare fee-for service payments for evaluation and management services, they will instead get a "hybrid of reduced Medicare fee-for-service payments and upfront comprehensive primary care payments for those services," CMS said.

Conway said that track one is estimated to be "budget neutral" — in other words, it is not expected to lead to net costs for the federal government.

Track two, according to conservative estimates, will lead to "almost $2 billion in savings" to the government, Conway said.

Under both tracks, Conway said, doctors "can deliver care the way they want to and the way patients want to receive that care."

He said the model will help lead to "better care, smarter spending and healthier people."

The regions that will be covered by the program have yet to be selected.

"This model is voluntary and we think there will be a high level of interest across the states and regions and across primary care providers, and we expect a high level of applications," Conway said.