What the Medicare “Doc Fix” Means for Seniors: Six Things To Know 

In a nutshell here is what the change in reimbursement for Medicare physician services means:

The House yesterday easily approved some of the biggest changes to Medicare since Congress created the drug benefit a decade ago.  While the measure still must be approved by the Senate and signed by President Obama (who supports it), it represents a significant shift in the way many seniors will get—and pay for—their health care.

The measure, known in Washington-speak as the “doc fix,” is primarily aimed at repairing the way Medicare reimburses physicians for the services they provide. But it is a complicated proposal that would do much more than that. It would raise Medicare premiums for high-income seniors, limit some benefits under Medicare Supplement (Medigap) insurance, continue funding some information services programs for older people, and begin a process aimed at changing the way doctors are paid by focusing more on quality care and health outcomes instead of simply paying by the procedure.

via What the Medicare “Doc Fix” Means for Seniors: Six Things To Know – Forbes.

However, what we should be focusing on is paying doctors based on “quality and value and outcomes.” Okay, as appealing as all that sounds, what the heck does it mean and how will it ever be quantified?  

Let’s consider a typical Medicare patient, my wife. She goes to an internist, dermatologist, plastic surgeon, oncologist, endocrinologist, ophthalmologist, gynocologist and a chiropractor plus a acupuncturist (which Medicare doesn’t consider medical care).  Some of the care she receives from these doctors overlaps with one or more, other care does not. From experience I can attest that much of the success of her treatment depended on her following the instructions she was given, sometimes at quite an inconvenience on her part. 

Now into this mix we are going to pay each doctor based on some quality measure, some outcome, some overall value … how?  Proponents of this payment methodology make it sound so easy and politicians jump on the easy out bandwagon. It’s as if patients have only one doctor handling all their care from start to finish and all patients are fully compliant with the doctor’s instructions and in taking medication prescribed. That’s not the real world. 

Making this methodology work while resulting in better management of costs and better care is an immense challenge that will also put a new burden on physicians and the doctor – patient relationship. 

We have not solved a problem, but we may have created a entire new one. Stand by as the real world meets theory‼️

One comment

  1. Excellent point, “quality care and health outcomes” are difficult to measure, not impossible, but difficult and expensive if done accurately. How many complex things of any kind do governments at any level measure accurately?

    What I find surprising is how seldom independent health policy experts discuss the elephant in the room ( maybe baby elephant): health care rationing. Great Britain and Canada already have the elephant full grown, who is called The Waiting List.

    When the current health care system (if the word ‘system’ can be applied to the clickety-clack hodge-podge currently operating) “matures” in five or ten years and is confronted by the bulk of the baby-boomer generation expecting expensive operations and medications, what then? Look north and across the Atlantic for answers.

    In all the discussions I have heard, seen and read about healthcare, very few policy experts even mention the problem. Those rare few that do admit rationing is as inevitable as it is now unspoken.


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