Viewpoint: What Medicare means for my practice

July 23, 2010

The 21 percent reduction in Medicare physician rates has been postponed for another six months. This matter will come up for review again after the fall elections.

On July 13, I viewed the webcast of the presentation at the Department of Health and Human Services (HHS) regarding meaningful use, health information technology standards, and certifications. The broadcast coincided with the release of the final meaningful use regulations, which could qualify physicians for $44,000 from Medicare over five years starting next year if they adopt the use of electronic health records and meet the requirements.

Based on the recent HHS presentation and the release of the meaningful use final rule, I believe the Centers for Medicare and Medicaid Services is serious about reforming the delivery of healthcare and will continue to be a valuable part of my practice. Our practice participates with Medicare, Medicare Advantage, and other commercial plans. A recent review of the Medicare reimbursement rates in our community is rather positive. As a primary care physician, I cannot speak to the reimbursement rates for many procedures and diagnostic tests. Many of my subspecialty peers have noted a sharp decline in reimbursement rates, which may affect their ability to update equipment in the future.

Medicare Advantage rates tend to be 30 to 40 percent lower, with some exceptions. At least one capitated Medicare Advantage plan pays significantly better, but a choice to participate in Medicare Advantage includes more than a fee schedule review. Plans that provide enhanced dental and vision benefits are valuable, because patients with poor nutrition or an inability to read the labels on their medication bottles will not realize the maximal benefit of our intervention.

Some plans provide enhanced "back-office" assistance to help practices manage chronic diseases. Pilot projects have been running that take back-office assistance to the next level and help practices become patient-centered medical homes (PCMHs). As the first solo practice in New York state to achieve PCMH Level III recognition from the National Committee on Quality Assurance, I can tell you that the plans' assistance is no small "perk." Case managers are assigned to reduce barriers to care. Nurses can assist with registry reports to help reach out to patients who may not consistently come to the office or follow through with the practice's recommendations.

Meaningful use dollars and enhanced reimbursement for PCMHs have the potential to help keep Medicare participation a favorable option for many practices in the years to come.

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