CMS Speeds Up ACA Payment Reform for Mid-Sized Physician Groups

CMS is accelerating by one year a plan to move thousands of physicians in medium-sized physician groups into an Affordable Care Act program that ties a portion of their Medicare reimbursements to the quality of their care, according to a draft rule released this month, Kaiser Health News/Washington Post reports.

Background

Under the ACA, by 2017 nearly 500,000 physicians working in group practices will begin receiving bonuses or penalties based on performance, in an effort reduce health care spending. Health policy experts argue that the current fee-for-service reimbursement system encourages doctors to perform more procedures, which they say drives up health costs. 

The ACA called for physician groups with 100 or more doctors to switch to the new payment system in 2015, under which they could gain or lose as much as 1% of their pay based on quality measures that differ by specialty. Many of the benchmarks will measure how frequently doctors follow basic medical approaches. The incentives would double, to 2%, in 2016.

Draft Rule Details

Under the draft rule, physicians in groups of between 10 and 99 doctors will now begin the program in 2016, one year earlier than originally scheduled. However, the payment structure will be slightly different in the first year. Physicians in mid-sized groups will be eligible for bonuses up to 2%, but will not face any penalties during the first year.

Smaller practices of nine or fewer physicians will begin the program in 2017.

Physician Groups Backlash

There has been backlash against the program among physician groups, who are pushing Congress to repeal the ACA provision. In a letter to the House Ways and Means Committee in April, the American Medical Association wrote, "To impose a program that takes money off the top of payments that have not kept up with inflation for more than 10 years will increase the migration of physicians into hospital settings, driving up overall Medicare spending in the process" (Rau, Kaiser Health News/ Washington Post, 7/22).