The Centers for Medicare & Medicaid Services has made a Medicare reimbursement policy decision that could eventually have broad, hard-to-predict effects on the kinds of people who buy health coverage from insurance agents and brokers.
CMS says it wants to leave the impact of uncompensated care out of the calculations used in new types of “alternative payment models,” or APMs.
CMS is developing the new payment models to comply with Medicare doctor pay provisions in the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA.
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Some physician groups asked CMS to make allowances in the new models for patients who fail to pay their bills, but CMS decided against doing that.
“We do not wish to downplay the financial impact of uncompensated care, but we believe that addressing such costs in the context of APMs is beyond the scope of this final rule,” CMS officials say in the introduction to a new batch of Medicare physician payment change final regulations. “We do not believe that such costs can be considered as financial risk under an APM in any systematic, quantifiable manner.”
CMS says it will gather public comments on the final regulations for 60 days before taking further action.
Implementation of the final regulations would have a direct, immediate effect only on Medicare physicians who get paid using the new APMs, but because Medicare is so big and has so much influence on how the rest of the U.S. health care system, the decision could eventually have an indirect effect on how Medicaid plans, individual commercial policies and even commercial group plans operate.
Dr. Jay Kaplan, president of the American College of Emergency Physicians, wrote in a letter sent to CMS in November that leaving the uncompensated care burden out of new types of Medicare reimbursement arrangements could hurt some types of physicians more than others.
Hospital emergency departments and emergency physicians, for example, “incur unique financial risks due to higher rates of uncompensated care,” Kaplan wrote at the time.
In theory, new Medicare pay rules that leave uncompensated care out of reimbursement arrangements could make specialties such as emergency care and urgent care less attractive, and specialties that give physicians more time to analyze incoming patients’ finances more attractive.
Congress created the MACRA Medicare physician payment fight to kill the old sustainable growth rate payment fights. (Photo: Thinkstock)
Out with SGR, in with APMs
Physicians provide some uncompensated care because they consciously agree to treat uninsured or underinsured patients for free.