Current Payment Challenges and New Payment Models
description
Transcript of Current Payment Challenges and New Payment Models
![Page 1: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/1.jpg)
![Page 2: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/2.jpg)
Current Payment Challenges and New
Payment Models
![Page 3: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/3.jpg)
Jonathan L. Myles, MDChair, Economic Affairs Committee
Current Payment Challenges and New Payment Models
May 7, 2012
![Page 4: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/4.jpg)
Session Objectives
• Discuss macro and micro payment policy pressures on physicians and pathologists specifically
• Examine CAP efforts exploring new payment options
• Identify federal and state economic payment policy initiatives
![Page 5: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/5.jpg)
Payment Threat for Physicians
• AMA working to prevent looming payment cutsoCAP, other groups reinforce
AMA efforts
• Thanks to AMA for preventing 2012 SGR cuts
• Working to prevent further cutsoSGR – 2013oIPAB – 2014 and beyond
![Page 6: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/6.jpg)
Revaluation of AP Services
• Congress increased Medicare’s authority to review services
• Stems from concerns that specialists are overpaid and primary care is undervaluedoPrimary care built case for increasesoShifting of funds results in budget
neutral environment • CAP is engaged in strategy to best
protect pathology services• Review is underway with CMS
implementation starting in 2013
![Page 7: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/7.jpg)
TC “Grandfather”
• Congress discontinued TC Grandfather effective July 1
• Argument on double payment accepted by Congress
• CAP supports permanent extension to preserve access in rural and small hospital settings
• Congress not expected to revisit in 2012
![Page 8: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/8.jpg)
Self-Referral: Close the Loophole
• Competition from other physicians creates economic strain on pathology practices
• Georgetown study demonstrates financial incentives increased utilization with lower cancer detection
• Self-referral results in increased use, increased costs, with little to no patient benefit
• CAP’s message to CMS, MedPAC and Congress: Close the loophole
![Page 9: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/9.jpg)
Direct Billing for Pathology Services
• CAP and State Societies together deter use of pathology as a profit center
• Successfully enacted direct billing in 15 states since 2003
• Latest successes: Colorado, Washington and Indiana
• States in the pipeline: Illinois
• Over $1.3 million spent since 2003oCAP - $632,252oState Pathology Societies - $691,500
![Page 10: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/10.jpg)
Exploring New Payment Options
• Case for Change: Better position specialty given economic pressures on pathologists and changing payment models
• Effort identified priority services based on impact and payment potential
• Areas examined:oEstimated market sizeoPayment potential/feasibilityoValue to pathologyoEase of implementation
![Page 11: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/11.jpg)
Exploring New Payment Options
• Three themes emerged in review:1. Genomics is important going
forward2. New technologies provide
opportunities to bring pathologists closer to patient
3. Getting “closer to the patient” will be important for pathologists in the changing landscape
![Page 12: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/12.jpg)
Exploring New Payment Options
• Services prioritized across two scenarios based on paymentoFee for service environmentoCoordinated care environment
• New services related to policy on ACOs, personalized medicine and health information technology
• Additional speakers will explore opportunities in these areas
![Page 13: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/13.jpg)
Exploring New Payment Options
• Actions to advance adoption were reviewed for identified prioritized services
• Example – In Vivo MicroscopyoIdentified Action - enable
payment through code development and valuation
oAdvocacy efforts−Securing unique pathology code
−Valuation activities planned
![Page 14: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/14.jpg)
How You Can Help
• Tell Congress to:oRepeal the SGR to ensure
stable payment systemoRemove the in-office exception
to the Stark self-referral law
![Page 15: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/15.jpg)
• Cecil B. Wilson, MD, Immediate Past President, American Medical Association
• Jonathan L. Myles, MD, FCAP, Chair, Economic Affairs Committee
Panel Discussion
![Page 16: Current Payment Challenges and New Payment Models](https://reader034.fdocuments.net/reader034/viewer/2022042608/5681404c550346895dabbea3/html5/thumbnails/16.jpg)