tci Medicare Compliance & Reimbursement - 2005 Issue 24
PHYSICIANS: PPAC Calls For Physicians To Share In Care Rewards
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Article Overview
This article covers a Practicing Physicians Advisory Council (PPAC) discussion about how Medicare might share hospital-side savings with physicians when care coordination and efficiency reduce costs. It also addresses physician concerns about pay-for-performance design, recovery audit contractor costs, and CMS rulemaking related to the Part B drug Competitive Acquisition Program. The piece is aimed at physicians, practice leaders, and coding or reimbursement professionals tracking Medicare policy and payment changes.
Why This Topic Matters
The article highlights Medicare payment policy ideas that could affect physician reimbursement, quality measurement, audit burden, and comment opportunities on CMS rulemaking. It is relevant to practices monitoring how performance programs and drug payment processes may influence operations and revenue.
Article Sections
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PPAC proposal to share Medicare savings with physicians
The article discusses a PPAC resolution about transferring some Medicare savings tied to physician efficiency from the hospital side to the physician side. It explains the general policy idea and the types of indicators discussed for measuring outcomes.
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Concerns about pay-for-performance and measurement design
This section summarizes physician concerns about pay-for-performance programs, including how measures may affect different practices and patient populations. It also discusses broader concerns about attribution, incentives, and technology-based rewards.
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Recovery audit contractor costs and CMS rulemaking comments
The article covers a PPAC recommendation that CMS account for physician costs associated with recovery audit contractor reviews. It also notes a separate resolution urging CMS to issue an interim final rule for the Part B drug Competitive Acquisition Program to allow more comment opportunity.
What You Will Learn
- The general policy issues involved in sharing Medicare savings with physicians
- Why physicians raised concerns about pay-for-performance programs
- How audit-related administrative costs were discussed in relation to Medicare oversight
- Why PPAC sought additional comment opportunities on a CMS drug payment proposal
Who Should Read This
- Physicians
- Medical practice administrators
- Health policy professionals
- Medical coders and reimbursement staff
- Healthcare compliance teams
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