The first section of the bill calls for reducing or eliminating costs, such as copayments or deductibles, that some Medicare patients face for primary care services delivered in rural health clinics or Federally Qualified Health Centers. Those costs are a barrier to care, says A. Mark Fendrick, MD, an internist and director of the University of Michigan’s Center for Value-Based Insurance Design.
When he sees some patients, Fendrick is incentivized to recommend certain prescription medications so that he can meet quality-of-care targets such as those that Medicare Advantage plans require. But some patients can’t afford those prescriptions because of high copayments or deductiblese, he adds.
“If Medicare or an insurance company is going to pay me more to recommend certain things for my patients, you better make it easy for my patients to do them,” he says.
One important part of the bill would eliminate the three-day hospitalization threshold that patients must meet before Medicare will pay for care in a nursing home or skilled nursing facility (SNF).
The bill will also lift restrictions that make it difficult for ACOs to get reimbursed for telemedicine and telemonitoring. “The idea is to make it easier for physicians and physician groups to provide care without regard to whether that care is virtual, face to face or in the home or office,” says Ira Nash, MD, senior vice president of Northwell Health, a New York-based ACO.
Joseph Burns is a journalist in Falmouth, Massachusetts. Do you think this bill would help your patients? Tell us at [email protected].