E/M Coding Alert - 2005 Issue 21
REIMBURSEMENT: Should Your Physicians Receive Rewards For Decreasing Hospital Spending?
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Article Overview
This article discusses a physician-payment and Medicare reimbursement policy debate centered on whether physicians should receive rewards when their care reduces hospital spending. It reviews concerns raised by members of the Practicing Physicians Advisory Council about pay-for-performance, the sustainable growth rate framework, recovery audit contractor costs, and a proposed Competitive Acquisition Program for Part B drugs. The piece is relevant to physicians, practice administrators, coding and billing professionals, and anyone tracking CMS payment policy changes.
Why This Topic Matters
Changes in Medicare payment policy can affect physician reimbursement, practice workflow, audit burden, and access to drug treatment programs. Understanding the policy issues discussed here helps readers anticipate how CMS initiatives may influence clinical operations and billing economics.
Article Sections
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Pay for performance and physician spending
Discusses the broader debate over linking physician rewards to measured performance and lower spending. It covers concerns about how efficiency, patient mix, and physician payment limits may interact.
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Measuring savings and performance
Describes the challenges of using indicators and control groups to assess whether physician care reduces downstream hospital utilization. The discussion stays focused on Medicare policy measurement concepts.
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Recovery audit contractor costs
Addresses the proposal that CMS consider the full costs associated with recovery audit contractor activity, including provider-side response costs. The section frames the issue as part of broader audit policy.
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Competitive Acquisition Program for Part B drugs
Covers concerns about CMS rulemaking for the Part B drug acquisition program and the requested opportunity for additional comment. It also touches on workflow and administration issues in chemotherapy practices.
What You Will Learn
- How the article frames the debate over physician rewards and hospital spending reductions
- Why some physicians argue that pay-for-performance can conflict with existing Medicare physician payment policy
- What policy concerns were raised about audit-related costs and Medicare rulemaking
- Why the Part B drug acquisition proposal generated concern among physicians and oncology practices
Who Should Read This
- Physicians
- Medical practice administrators
- Medical coders and billers
- Healthcare reimbursement professionals
- Policy analysts
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