An article in the New York Daily News, “The next healthcare crisis: Changes in way Medicare pays doctors,” highlights a piece of federal legislation quietly passed with little fanfare that may have tremendous negative effects on disabled patients.
The Medicare Access and CHIP Reauthorization Act (MACRA) fundamentally transforms how Medicare pays doctors and hospitals. MACRA ties payment to outcomes. Good outcomes = better payments. Bad outcomes = worse payments. This creates a perverse incentive for doctors to paint the brightest picture of health and outcomes for their patients, in order to secure better payment.
The final rules were released last October, when most people were watching the presidential race, and is a significant and complex change in Medicare.
MACRA changes the traditional Medicare payment model - provider sends a bill to Medicare and is paid a set fee. Under MACRA, the doctor or hospital’s payment is based on what the outcome was. The thought is that by focusing on better outcomes, better results will be achieved. But, the law is poorly crafted, and the results will likely be devastating to those fighting for disability benefits.
Not every illness can be cured and not every injury can be fixed. Tying payments to outcomes “achieved” may result in doctors being less willing to document significant impairments, especially over time, due to the potential negative effect on their bottom line.
This may also result in doctors leaving the Medicare system when patient outcomes are not as good as they would like resulting in fewer doctors treating Medicare patients, at the same time that large numbers of Baby Boomers enter the Medicare system.
Another effect is that many health insurance companies may adopt similar repayment strategies. This can further affect both accurate documentation of patient outcomes as well as acceptance of health insurance.
The new rules go into effect starting January 1, 2019. It will be interesting to see how this affects medical care and documentation in chronically ill and/or permanently injured patients.