Changes In The Medicare-Based Physician Formula

Published April 23rd, 2015 by USA Rx
Fact Checked by
Chris Riley

Changes In The Medicare-Based Physician FormulaAccording to Kaiser Health News, we may be witnessing the end of the Medicare-based physician payment formula and see affluent seniors paying considerably more to their doctors for the care they receive. Just hours prior to facing a Medicare pay cut of up to 21%, the US Senate passed legislation in the late evening of April 14th, 2015 to do away with the current payment formula. Democratic leader Nancy Pelosi and Speaker John Boehner helped muscle the bipartisan plan through congress.

Under this new legislation, doctors will be using a new reimbursement schedule that includes pay increases during the next 5 years. The new “Merit-Based Incentive Payment System” focuses on physician accountability, quality of care, and value while incorporating existing payment programs under this new format. Additionally, we will see the creation of other alternatives to the current payment model. For the millions of Medicare beneficiaries and their primary care physicians, this legislation should end any uncertainties about the issue.

The facilitation of these innovative cost models will supposedly improve the quality of care that Medicare patients receive and even lower the costs involved. However, despite the positive results that are expected, this legislation is a mixture of many different factors. For instance, the CHIP (Children’s Health Insurance Program) will receive additional funding over the next 24 months. Additionally, healthcare providers and Medicare beneficiaries will see a number of policy changes that govern how much will be paid.

The primary concern of numerous aging and consumer organizations is that beneficiaries will be paying increased out-of-pocket costs and higher premiums for Medicare Part B coverage in order to help finance Medicare payments to physicians. USA Rx has posted this content in order to keep our cardholders aware of current health insurance news and trends in health care. We encourage you to visit our blog and read the information we have posted there. For more information visit our website, call our toll-free number (888) 277-3911, or e-mail us at [email protected].

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