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December 18, 2020

Building a Better Clinician Value-Based Payment Program in Medicare

Author Affiliations
  • 1Department of Health Management and Policy and Department of Health and Clinical Outcomes Research, St Louis University, St Louis, Missouri
  • 2Department of Health Policy and Management, Emory University, Atlanta, Georgia
  • 3Washington University Center for Health Economics and Policy, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 4Associate Editor, JAMA
JAMA. 2021;325(2):129-130. doi:10.1001/jama.2020.22924

Medicare provides coverage for approximately 62 million individuals in the United States and accounts for $750 billion in health care spending annually1; if the Medicare eligibility age is lowered, these numbers will increase. Of this total, 27.2% is spent on clinician, outpatient, and other services in Medicare’s traditional Part B program. Throughout the 1990s and 2000s, the Part B program experienced unwarranted variation in care quality and high per capita annual expenditure growth rates of 6.3% and 7.0%, respectively.2 Consequently, the Affordable Care Act, enacted in 2010, and the Medicare Access and CHIP Reauthorization Act, enacted in 2015, included provisions for implementing a wide array of value-based payment (VBP) programs in Part B, with the hope that paying clinicians for value rather than volume would improve quality and reduce the rate of growth in Medicare costs (see key terms for Medicare VBP in the Supplement).

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    2 Comments for this article
    Payment Program in Medicare
    Karl Stecher, Harvard AB, Maryland MD | Retired neurosurgeon
    Physicians take care of patients as their primary goal but are burdened by outside demands on their attention.

    Medicare pays so little that it is comparable to paying 60 cents a gallon for gas and claiming to the station owner that is the correct amount, and there is nothing the gas station owner can do about it. So it is with Medicare.

    Why should doctors, who have endured long training, long hours, awesome responsibility for the lives of their patients, have to be burdened with a game the federal government has concocted which does not really change practice
    that much? It is just another burden on the physician.

    With the pittance that Medicare pays, any program to incentivize value-driven care would be comparable to paying 62 cents instead of 60 for "good behavior," or 58 cents if those federally contrived goals are not met.
    And don't forget that most states already require continuing education to maintain a license.

    When will the AMA fight for a true increase in reimbursement? That's the reform needed, not global coverage. And when will it fight back against the government's procedure and attitude of punishing physicians?
    The Problem
    Nathan Kaufman, Masters in Health System | Consultant to Real-World Health Systems and Physicians
    The problem is that none of these programs are "working." They are a bureaucratic nightmare for physicians and hospitals and have provided no material measurable long-term improvement in cost or true quality, i.e., outcomes for patients. Most of the data cited are self-reported and cherry-picked from payers who stand to profit  

    As one who is of Medicare age and a healthcare expert, I would never go into an Medicare Advantage (MA) plan and expose myself to a limited network. What most people do not know is that after a year under MA, Medicare supplemental plans are no longer community-rated
    and thus pre-existing conditions are excluded. Thus Medicare patients that want to switch back to FFS are at a disadvantage.

    Most docs hate MA, ACOs, and value-based nonsense.