American Medical Association’s Post

I always struggle to understand the justification of these ongoing Physician pay cuts by Medicare. If we didn't know better, we would assume that Inflation rates didn't have an impact on Practice operations - even though we continue to witness annual inflation adjustments from HHS- with HIPAA violations, DOL- with OSHA violations, etc. Essentially, all operational expenses are adjusted for inflation, yet reimbursements keep getting slashed. How is this sustainable? It's almost as if there's an ulterior motive at play, but maybe I'm just being paranoid. #MedicarePhysicianPayCut #MedicarePayments

Last Friday, the Senate Finance Committee released a bipartisan white paper outlining policy concepts reforming how Medicare Part B pays physicians with the aim of improving care for those with chronic conditions and addressing challenges like provider burnout, rising practice costs, and the need for better care coordination. Proposed reforms include: - Revising Medicare Physician Fee Schedules to account for inflation, reduce payment volatility, and better reflect the costs and resources required to provide high-quality care. - Considering examining and extending hybrid payment models that combine per-beneficiary, per-month payments with traditional fee for service payments. - Promoting value-based care by increasing incentives, reducing the administrative burden, and streamlining reporting requirements for participation in alternative payment models. - Permanently extending measures that increased access to telehealth services during the COVID pandemic to maintain access to care for behavioral health and chronic disease management. 📘 Read the full white paper for detailed insights and policy recommendations. https://lnkd.in/guy35RwY #HealthcareReform #Medicare #ChronicCare #Telehealth #ValueBasedCare

The extent of physician under-payment has whole health system implication, of particular concern is the impact on brain-drain between LMIC and HIC where doctors emigrate to high income countries in order to earn what they consider to be a reasonable income. This further exacerbates health disparities (rural-to-urban migration and public-to-private migration), limits access for communities (reduced availability of doctors), and drives up costs due to need for expensive temporary staffing solutions or increased demand for overtime. The impact of often highest in already underserved communities leading to further inequities. What is often not talked about is the direct impact on doctors’ financial and emotional wellbeing. #TransformingHealthcare #CurisHealthcareSolutions

As this New York Times analysis shows, spending per #Medicare beneficiary has nearly leveled off over more than a decade. The analysis notes that "... more care has shifted outside #hospitals into cheaper settings." ASCs have undoubtedly contributed to the Medicare spending decline and are likely to continue doing so. #outpatient #outpatientsurgery #ambulatorysurgery #surgerycenter

An whole smorgasbord of chronic #physician beefs exposed at a Senate hearing yesterday: declining #Medicare unit pricing, #PrimaryCare vs specialist payment (there’s that annoying budget neutrality thing), the cloister of the #AMA RUC dividing up the federal physician payment pie, administrative complexity in #quality measurement & reporting, the predictable prior authorization whining, the absence of a business case for coordination of care for the chronically ill in our fragmented fee-for-service third-party-payor “system”. But don’t expect any major reforms any time soon. It’s an election year & it’s taken 15 years for the dust to settle on #ObamaCare. Meanwhile, expect all the major #healthcare players will continue to snipe at one another each while driving to consume a larger portion of the US economy.

🚨🚀 Big Changes Coming to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act! 🚀🚨 As healthcare continues to evolve, it's crucial for current and prospective Medicare enrollees to stay informed about new developments. The changes under the Inflation Reduction Act are set to bring notable benefits for Medicare Part D enrollees. Here's what you need to know: 🔍 **What’s changing?** - **Lower Out-of-Pocket Costs:** Starting in 2024, a $2,000 out-of-pocket cap will be established, easing financial burdens for many enrollees. - **Price Negotiations:** Medicare will now be able to negotiate the prices of certain high-cost drugs, ultimately reducing costs for enrollees. - **Expanded Coverage:** Additional benefits are slated to begin in 2025, including increased subsidy levels for low-income enrollees. 📈 **How Will These Changes Benefit You?** - **Financial Relief:** The $2,000 cap will reduce stress related to high prescription costs. Say goodbye to unexpectedly high bills! - **Affordable Medication:** With Medicare negotiating drug prices, the cost of essential medications will be more manageable. - **Greater Access:** Enhanced access to medications and services means better health outcomes, especially for those on limited incomes. 🔗 **Why It Matters:** Health equity and affordability are central to these updates. It ensures that all enrollees have a better quality of life without the looming worry of escalating healthcare costs. 💬 Have your thoughts? Let’s discuss how these changes might impact you or your loved ones! Share your insights or questions below. 🌟 #Medicare #HealthcareReform #InflationReductionAct #MedicarePartD #HealthcareSavings #TwoAgenciesInc --- This post sums up the substantial alterations coming to Medicare Part D, contextualizing their benefits in an informative yet engaging manner. Stay proactive and stay informed! 📚✨

Wondering why you or your parent or grandparent can't find a physician who will accept Medicare? Running a practice and caring for patients is becoming unsustainable for physicians. This year’s 3.37% Medicare physician pay cut comes on top of the 2% cut physicians saw in 2023. When adjusted for inflation prior to this year’s pay cut, the payment rate to physicians who care for Medicare patients was 26% LESS than it was in 2001. Physicians fall into the ONLY GROUP that does not get an annual inflation increase to cover the rising costs of doing business. Help AMA to #FixMedicareNow by reversing these unconscionable cuts, before it is too late for your loved older family member.

After several April Fools jokes, these takeaways the @Health Data Decisions SMEs shared with me on the Final CMS 2025 Notice are no joke. https://lnkd.in/e_-sxHbQ 1.      MA Plans will see a 3.651% increase in revenue reflecting an increase from the effective growth rate and MA risk score trend. The increase in FFS is likely to be offset by risk adjustment model changes. This means that payors need to prioritize and maintain a rigorous documentation process under v28. 2. Risk Model changes will continue to be phased in with member Part C risk scores calculated based on 67% from the v28 model, CMS-HCC 2024, and 33% from v24, CMS-HCC 2020. A. The increase in HCC detail and LIS impact requires documentation of conditions at the highest level of specificity and verification of member status. With the majority of the risk score derived from v28 payors need to make sure coding practices line up with v28 diagnoses. 3. An updated Part D model will also be released using 2021 diagnoses and 2022 expenditures. Part D payments will incorporate Inflation Reduction Act changes that eliminate the coverage gap, reduce out of pocket threshold to $2,000 and offer OOP payment flexibility to members. A. Changes in benefit design will impact utilization and medication adherence. Payors must actively and closely monitor their drug utilization data to understand how to respond to these changes. B. The Inflation Reduction Act of 2022 has led to the Medicare Prescription Plan Payment (M3P) to be effective January 1, 2025, in which members will have the option to pay for their out-of-pocket RX costs in monthly amounts that are spread throughout the plan year and are subject to maximum monthly caps. Plans will need to educate members who are likely to benefit from this option, enrollment staff, and PBM and pharmacy partners on these changes for enrollees who elect this benefit. Plans should consider the Star Ratings impact for the key med adherence measures that are likely to be impacted. 4. Future Stars model changes are likely to be influenced by measures in the "Universal Foundation". For info on Universal Foundation click https://lnkd.in/ejbUe7QM 5. 51% of eligible enrollees are now in MA plans, with competitive plan options at the county level. Future expansion for MA enrollment is likely greatest in rural areas, and in counties with less than 10,000 eligible members. Reaching and serving these eligible enrollees should go a long way to increasing health equity. #CMS #MedicareAdvantage #StarRatings #M3P 

Clearing up patient misconceptions on physician payment is a good start. Learn how the #OurAMA is leading the charge to reform #Medicare pay.