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Shawn Fox
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Richardson
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Question everything.
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http://hosted.ap.org/dynamic/stories/U/US_MEDICARE_OVERHAUL?...

The rules don't go into effect until 2019, but these rules are based off of a reform that was heavily supported by both Democrats and Republicans. The basic idea is to provide incentives for doctors to provide better care by offering extra payments based on actual results rather than just a fee per service arrangement as is done now. To participate in the program doctors have to use electronic records so that the Medicare system can track patient results.

The current system we use today, both in Medicare as well as standard physician practice, where doctors are paid on a free for service model is obviously broken. It offers too much incentive for doctors to abuse the system by pushing patients towards procedures which are profitable for the doctor even though they are not necessary. Not every doctor abuses the system in this way, of course, but a substantial percentage of them do. The financial incentive is just too hard to ignore in many cases, even for honest doctors.
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Shawn Fox
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FAQ on MACRA:
http://www.aafp.org/practice-management/payment/medicare-pay...
 
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Matthew Schoell
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sfox wrote:
http://hosted.ap.org/dynamic/stories/U/US_MEDICARE_OVERHAUL?...

The rules don't go into effect until 2019, but these rules are based off of a reform that was heavily supported by both Democrats and Republicans. The basic idea is to provide incentives for doctors to provide better care by offering extra payments based on actual results rather than just a fee per service arrangement as is done now. To participate in the program doctors have to use electronic records so that the Medicare system can track patient results.

The current system we use today, both in Medicare as well as standard physician practice, where doctors are paid on a free for service model is obviously broken. It offers too much incentive for doctors to abuse the system by pushing patients towards procedures which are profitable for the doctor even though they are not necessary. Not every doctor abuses the system in this way, of course, but a substantial percentage of them do. The financial incentive is just too hard to ignore in many cases, even for honest doctors.


I think it's simpler than a small handful of bad doctors. Fee for service creates an unconscious bias towards additional fees, which becomes visible in the culture of medicine, which reinforces the bias and so on and so forth. It doesn't require bad actors, a certain amount of creep is probably responsible for a lot of over testing.

These new rules are important, and have the chance to do a lot of good.
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jeremy cobert
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if payments are based on "actual results" there has to be some measure on how they rank results ? If so, wont the issues that never improve like back injuries be seen less often then the simple things that have rapid improvements ?

 
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Shawn Fox
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jeremycobert wrote:
if payments are based on "actual results" there has to be some measure on how they rank results ? If so, wont the issues that never improve like back injuries be seen less often then the simple things that have rapid improvements ?

We'll probably see a lot less people being referred to surgery for back pain considering how ineffective it generally is.

I've no idea what all the details are, there are 1200 pages of rules. I assume such a long set of rules is needed because there are rules specific to a lot of different types of injuries and/or medical professions. No system will ever be perfect, but at a high level this sounds like a step in the right direction to me. It could just end up being a huge mess if the rules are too complicated to understand and manage. That said, it can't be much worse than the current free for service model and it least it is an attempt to fix a known problem.
 
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J.D. Hall
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jeremycobert wrote:
if payments are based on "actual results" there has to be some measure on how they rank results ? If so, wont the issues that never improve like back injuries be seen less often then the simple things that have rapid improvements ?


The way my doctor explained it is that there are professional metrics built into the system that enable doctors' progress to be measured even if the result isn't positive (think oncologists or those who provide Hospice care). It's complicated, but hell, so is medicine. I personally think it's a good idea -- fee for service screws up the entire system. But there will be bugs, oh yes, there will be bugs.
 
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Mac Mcleod
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informative post!
 
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